Active NPI
Tracy Leigh Chisholm, PSY.D.
- Clinical Psychologist
- West Linn, OR
National Provider Identifier
1003240078
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 001273
- Practice address
- 22400 Johnson Rd
West Linn, OR 97068-9722 - Phone
- (850) 294-5733
- NPI assigned
- Aug 27, 2013
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 001273 | IA | Primary |
Addresses
Primary practice location
22400 Johnson Rd
West Linn, OR 97068-9722
Mailing address
22400 Johnson Rd
West Linn, OR 97068-9722
Phone (850) 294-5733
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 001273 | IA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1377561600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1377561600000",
"number": "1003240078",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "22400 JOHNSON RD",
"city": "WEST LINN",
"state": "OR",
"postal_code": "970689722",
"telephone_number": "850-294-5733"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22400 JOHNSON RD",
"city": "WEST LINN",
"state": "OR",
"postal_code": "970689722",
"telephone_number": "850-294-5733"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHISHOLM",
"first_name": "TRACY",
"middle_name": "LEIGH",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-08-27",
"last_updated": "2013-08-27",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IA",
"license": "001273",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Linn, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 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.