Jeremy Wilson Kenney, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

2210 Issued in OR

Practice address

2905 River Rd S
Salem, OR 97302-9754

Phone

(971) 258-7993

NPI assigned

Mar 6, 2013

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)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Professional Therapeutic Community Network, Inc

  • Community/Behavioral Health Agency
  • Salem, OR
  • NPI 1629223243
  NPD (past)
• Professional Therapuetic Community Network

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Salem, OR
  • NPI 1548636079
  NPD (past)

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

{
    "created_epoch": "1362528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1362528000000",
    "number": "1114268802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2905 RIVER RD S",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973029754",
            "telephone_number": "971-258-7993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2905 RIVER RD S",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973029754",
            "telephone_number": "971-258-7993"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEY",
        "first_name": "JEREMY",
        "middle_name": "WILSON",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-03-06",
        "last_updated": "2013-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "OR",
            "license": "2210",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brian Dennis Kennedy, MD
• Christine Elizabeth Kennedy, EPDH
• Kristin Joy Kennedy, LMT
• Kenneth M. Wilson, M.D., P.C.
• Cassandra Ann Kenney
• Joseph Kenoyer, M.D.
• Austin Deryk Kent
• Carlin Kent
• Jeremiah Kent, BEHAVIOR TECHNICIAN
• Shannon M Kent

• Clinical Psychologist in Salem, OR
• Providers in Salem, OR by specialty
• Clinical Psychologist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 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.

Verify at the official NPI Registry.