Active NPI
Karen E Stallwood, PSY.D.
- Psychologist
- Portland, OR
National Provider Identifier
1104149004
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 2060
- Practice address
- 3939 NE Hancock St
Suite 212
Portland, OR 97212-5321 - Phone
- (503) 704-3300
- NPI assigned
- Mar 5, 2010
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 2060 | OR | Primary |
Addresses
Primary practice location
3939 NE Hancock St
Suite 212
Portland, OR 97212-5321
Mailing address
3939 NE Hancock St
Suite 212
Portland, OR 97212-5321
Phone (503) 704-3300
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Jan 1, 2025 through Jan 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1267747200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1318464000000",
"number": "1104149004",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3939 NE HANCOCK ST",
"address_2": "SUITE 212",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972125321",
"telephone_number": "503-704-3300"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3939 NE HANCOCK ST",
"address_2": "SUITE 212",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972125321",
"telephone_number": "503-704-3300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STALLWOOD",
"first_name": "KAREN",
"middle_name": "E",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-03-05",
"last_updated": "2011-10-13",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "OR",
"license": "2060",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.