1. Home
  2. Directory
  3. Minnesota
  4. Lake Elmo
  5. Counselor
  6. NPI Profile

JEFFREY CARL PEDERSEN LADC
NPI 1750190492
Counselor - Addiction (Substance Use Disorder) in Lake Elmo, MN

Active since January 07, 2025
9896 57TH ST N, LAKE ELMO, MN 55042(651) 285-2865 Get Directions Write a Review

NPPES record last updated: January 7, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Jeffrey Carl Pedersen Ladc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JEFFREY CARL PEDERSEN LADC (NPI 1750190492) is an individual addiction (substance use disorder) provider in Lake Elmo, Minnesota, licensed in Minnesota (305311) and active in the NPI registry since January 2025.

NPPES Registry Identity

NPI1750190492
Entity TypeIndividualMale
Primary Taxonomy101YA0400X
Provider Legal NameJEFFREY CARL PEDERSENCredential: LADC
Location Address9896 57TH ST NLake Elmo, MN 55042-9588
Mailing Address9896 57th St NLake Elmo, MN 55042-9588 · (651) 285-2865
Phone(651) 285-2865
Sole ProprietorYes
Enumeration DateJanuary 7, 2025
NPPES CertifiedJanuary 7, 2025
✔ NPI 1750190492 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Addiction (Substance Use Disorder)Behavioral Health & Social Service Providers
Taxonomy Code101YA0400X
License✔ Licensed in MN · 305311
9896 57TH ST N, Lake Elmo, MN 55042
Open in Google Maps ↗

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jeffrey Pedersen's NPI number?

The NPI number for Jeffrey Pedersen is 1750190492. It was assigned to this individual provider in the NPPES registry on January 7, 2025.

Where is Jeffrey Pedersen located?

Jeffrey Pedersen practices at 9896 57th St N, Lake Elmo, MN 55042. The listed phone number is (651) 285-2865.

What is Jeffrey Pedersen's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Addiction (Substance Use Disorder), with taxonomy code 101YA0400X.

When was this NPI record last updated?

The NPPES record for Jeffrey Pedersen was last updated on January 7, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.