Active NPI
David Dedrickson
- Mental Health Counselor
- Happy Valley, OR
National Provider Identifier
1902147127
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Practice address
- 11211 SE 82ND Ave
Suite O
Happy Valley, OR 97086-7624 - Phone
- (503) 722-6200
- Fax
- (503) 722-6545
- NPI assigned
- Mar 13, 2013
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | Primary |
Addresses
Primary practice location
11211 SE 82ND Ave
Suite O
Happy Valley, OR 97086-7624
Mailing address
2051 Kaen Rd
Suite 367
Oregon City, OR 97045-4035
Phone (503) 742-5300
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| County of Clackamas Office of County Auditor | 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.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Happy Valley, OR
- NPI 1801142781
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1363132800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1363132800000",
"number": "1902147127",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2051 KAEN RD",
"address_2": "SUITE 367",
"city": "OREGON CITY",
"state": "OR",
"postal_code": "970454035",
"telephone_number": "503-742-5300",
"fax_number": "503-742-5979"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11211 SE 82ND AVE",
"address_2": "SUITE O",
"city": "HAPPY VALLEY",
"state": "OR",
"postal_code": "970867624",
"telephone_number": "503-722-6200",
"fax_number": "503-722-6545"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEDRICKSON",
"first_name": "DAVID",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-03-13",
"last_updated": "2013-03-13",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Happy Valley, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.