Ginger Lyn Pederson, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

2761 Issued in MN

Practice address

3950 3Rd St N
Saint Cloud, MN 56303-4033

Phone

(320) 253-5930

Fax

(320) 258-4632

NPI assigned

Jun 24, 2009

Last updated

Jun 24, 2009By the provider in NPPES

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)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Village Family Service Center

  dba The Village Family Service Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Fargo, ND
  • NPI 1568492353

  Clinical

  NPD (past)
• Village Family Service Center

  dba The Village Family Service Center

  • Substance Abuse Rehabilitation Facility
  • Fargo, ND
  • NPI 1952679318
  NPD (past)

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

{
    "created_epoch": "1245801600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1245801600000",
    "number": "1891923272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 25TH ST S",
            "address_2": "PO BOX 9859",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581032311",
            "telephone_number": "701-451-4900",
            "fax_number": "701-451-4893"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3950 3RD ST N",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563034033",
            "telephone_number": "320-253-5930",
            "fax_number": "320-258-4632"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEDERSON",
        "first_name": "GINGER",
        "middle_name": "LYN",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-06-24",
        "last_updated": "2009-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "2761",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sue Peck, PT
• Matthew Albert Peckskamp, PA-C
• Cassandra Elizabeth Pedersen, RD
• Gwen Katrina Pedersen, M.S.
• Erin Marie Pederson, PA-C
• Jeremy Pederson, BSN, PHN
• Megan Ryleigh Pederson
• Marilyn J Peitso, MD
• Cheryl Pekarek, RN
• Roger John Pekula, PHARMD

• Clinical Social Worker in Saint Cloud, MN
• Providers in Saint Cloud, MN by specialty
• Clinical Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2009; 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.