Active NPI
Aimee Edwards Gaedecke, MA, LPC
- Professional Counselor
- Boise, ID
National Provider Identifier
1891313664
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- LPC-1021
- Practice address
- 161 E Mallard Dr
Boise, ID 83706-5015 - Phone
- (208) 605-3657
- Fax
- (208) 620-2306
- NPI assigned
- Jul 8, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | LPC-1021 | ID | Primary |
Addresses
Primary practice location
161 E Mallard Dr
Boise, ID 83706-5015
Mailing address
17015 Turin RDG
San Antonio, TX 78255-3801
Phone (757) 323-6033
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Mar 6, 2024 through Mar 6, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPC-1021 | ID | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cultivation, LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Behavioral Health Agency
- Coeur D'Alene, ID
- NPI 1124466990
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1594166400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1594166400000",
"number": "1891313664",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17015 TURIN RDG",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782553801",
"telephone_number": "757-323-6033"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "161 E MALLARD DR",
"city": "BOISE",
"state": "ID",
"postal_code": "837065015",
"telephone_number": "208-605-3657",
"fax_number": "208-620-2306"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GAEDECKE",
"first_name": "AIMEE",
"middle_name": "EDWARDS",
"name_prefix": "Mrs.",
"credential": "MA, LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-07-08",
"last_updated": "2020-07-08",
"certification_date": "2020-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "ID",
"license": "LPC-1021",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boise, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.