Miranda S Pederson, CSAC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

16399-132 Issued in WI

Practice address

306 S Barstow St
Eau Claire, WI 54701-3678

Phone

(715) 855-5300

NPI assigned

Feb 25, 2021

Sex

Female

Sole proprietor

Yes

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": "1614211200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614211200000",
    "number": "1891389342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "306 S BARSTOW ST",
            "city": "EAU CLAIRE",
            "state": "WI",
            "postal_code": "547013678",
            "telephone_number": "715-855-5300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "306 S BARSTOW ST",
            "city": "EAU CLAIRE",
            "state": "WI",
            "postal_code": "547013678",
            "telephone_number": "715-855-5300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEDERSON",
        "first_name": "MIRANDA",
        "middle_name": "S",
        "credential": "CSAC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-02-25",
        "last_updated": "2021-02-25",
        "certification_date": "2021-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WI",
            "license": "16399-132",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Madilyn Pearson, M.A. CCC SLP
• Robert Curtis Peck, MD
• Susan D Peck, RN, PHD, GNP-BC
• Sarah J. Pedersen, RDH, CDHC
• Lori Pederson
• Thomas Edward Pederson, MD
• Johann M Peikert, MD
• Brooke Ann Pelke, PA-C
• Aaron Pelle
• Thomas P Peller, M.D.

• Addiction (Substance Use Disorder) Counselor in Eau Claire, WI
• Providers in Eau Claire, WI by specialty
• Addiction (Substance Use Disorder) Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 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.