KIMBERLEY MARIE EDENS, LADC — NPI 1205955978 (Licensed & Credentialed Counselor, Addiction (Substance Use Disorder) in MINNEAPOLIS, MN)

CMS-1500 Box 24J / 33a • NPI

1205955978

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

101YA0400X

Licensed & Credentialed Counselor, Addiction (Substance Use Disorder)

Box 32 Service Location & ZIP+4

1121 JACKSON ST NE, SUITE 105, MINNEAPOLIS, MN, 55413-1672

✓ 9-Digit EDI 837 ZIP+4 (55413-1672)

Practice Phone & Referral Fax

(612) 236-1705

Fax: (612) 236-1701

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1205955978 (KIMBERLEY MARIE EDENS, LADC) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

This practitioner does not currently appear in the CMS individual Order & Referring PECOS file (may practice in pediatrics, commercial-only networks, or hospital-employed settings).

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1205955978` (NPI-1 Individual Practitioner)
Provider / Legal Name	KIMBERLEY MARIE EDENS, LADC
Plain-English Specialty	Licensed & Credentialed Counselor, Addiction (Substance Use Disorder) NUCC Code: `101YA0400X` (Counselor, Addiction (Substance Use Disorder))
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	1121 JACKSON ST NE, SUITE 105, MINNEAPOLIS, MN, 55413-1672
Practice Telephone / Fax	Tel: (612) 236-1705 \| Fax: (612) 236-1701
Administrative Mailing Address	763 2ND ST, HAMMOND, WI, 54015-9781
Enumeration & Last Sync	Enumerated: 2007-03-27 \| CMS Record Updated: 2007-07-08

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

1121 JACKSON ST NE, SUITE 105, MINNEAPOLIS, MN, 55413-1672

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Plain-English Taxonomy & CMS Crosswalk (101YA0400X)

What Does Taxonomy Code 101YA0400X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 101YA0400X translates to:
"Licensed & Credentialed Counselor, Addiction (Substance Use Disorder)"

CMS-1500 Medicare Specialty Crosswalk: Standard HIPAA X12N 837P / CMS-1500
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Counselor, Addiction (Substance Use Disorder) for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (KIMBERLEY MARIE EDENS, LADC)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`101YA0400X` — Counselor, Addiction (Substance Use Disorder) Plain English: Licensed & Credentialed Counselor, Addiction (Substance Use Disorder)	State: MN \| License: `301386` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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KIMBERLEY MARIE EDENS, LADC (NPI #1205955978)