Kenneth Edward Serkownek, PHD

Primary specialty

Counseling PsychologistTaxonomy code 103TC1900X

License

587 Issued in OR

Practice address

770 SE Kane St
Roseburg, OR 97470-3943

Phone

(541) 673-0057

Fax

(541) 673-2270

NPI assigned

Jan 7, 2009

Sex

Male

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

Credentials

Doctor of Philosophy

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

{
    "created_epoch": "1231286400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1231718400000",
    "number": "1033356423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "770 SE KANE ST",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974703943",
            "telephone_number": "541-673-0057",
            "fax_number": "541-673-2270"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "770 SE KANE ST",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974703943",
            "telephone_number": "541-673-0057",
            "fax_number": "541-673-2270"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SERKOWNEK",
        "first_name": "KENNETH",
        "middle_name": "EDWARD",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-01-07",
        "last_updated": "2009-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "OR",
            "license": "587",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David G Seibel, DO
• Mary Lee Seidler, RN
• Mary Selken, CADC
• Polly M Sepulvado, M.D.
• Serenity Lane
• Erin Suzanne Severson-Hobson, RPH
• Kimberly Sewell
• Linda L Sewell, MD
• Ernst Udey Shadbolt, CADC I
• Bex Shahi, O.D.

• Counseling Psychologist in Roseburg, OR
• Providers in Roseburg, OR by specialty
• Counseling Psychologist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 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.