Lacey D Pegram-Olson, LADC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

305948 Issued in MN

Practice address

343 Woodlake Dr SE
Rochester, MN 55904-6242

Phone

(507) 289-2089

NPI assigned

Jan 28, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1611792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611792000000",
    "number": "1861083206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "343 WOODLAKE DR SE",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559046242",
            "telephone_number": "507-289-2089"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "343 WOODLAKE DR SE",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559046242",
            "telephone_number": "507-289-2089"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEGRAM-OLSON",
        "first_name": "LACEY",
        "middle_name": "D",
        "credential": "LADC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-01-28",
        "last_updated": "2021-01-28",
        "certification_date": "2021-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "305948",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kara Jeane Pederson, LGSW
• Robin M Pederson, LICSW
• Abraham Peedicayil, MBBS
• Prema P Peethambaram, M.D.
• Nathan Peffley, MD
• Tobias Peikert, M.D.
• Laura Isabel Pelaez, MD
• Mario C Pelaez, MD
• Lindsey Jo Pelke, PA
• Patrick J Peller, MD

• Addiction (Substance Use Disorder) Counselor in Rochester, MN
• Providers in Rochester, MN by specialty
• Addiction (Substance Use Disorder) Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.