Individual provider Active NPI

Michelle L Krummenacker, LCSW

  • Clinical Social Worker
  • Clackamas, OR
National Provider Identifier
1124033618
Registry record updated Jun 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
L3197 Issued in OR
Practice address
9123 SE Saint Helens St Ste 100F
Clackamas, OR 97015-6800
Phone
(503) 740-1971
Fax
(503) 771-2436
NPI assigned
Jul 31, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X 98-07-34 OR
Clinical Social Worker 1041C0700X L3197 OR Primary

Addresses

Primary practice location

9123 SE Saint Helens St Ste 100F
Clackamas, OR 97015-6800

Mailing address

10117 SE Sunnyside Rd
Suite F, Box 1217
Clackamas, OR 97015-7708
Phone (503) 740-1971

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070514000283 OR Practitioner - Clinical Social Worker 5294832051 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Chaise Group LLCGroup PAC ID 7911006929, 6 clinicians

Practice addresses (Care Compare)

1217 NE Burnside Rd
Suite 701
Gresham, OR 97030-5770
Phone (503) 740-1971

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
L3197ORMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Chaise Group, LLC Addiction (Substance Use Disorder) CurrentSince Nov 22, 2008 Accepting new patients

Locations

11211 SE Sunnyside Rd
Clackamas, OR 97015
Phone (503) 513-7425

9123 SE Saint Helens St
Ste 100F
Clackamas, OR 97015
Phone (503) 740-6449

10117 SE Sunnyside Rd
#F1217
Clackamas, OR 97015
Phone 50374019711010

10117 SE Sunnyside Rd
Ste F1217
Clackamas, OR 97015

9123 SE Saint Helens St
Ste 100C
Clackamas, OR 97015

1217 NE Burnside Rd
Ste 704
Gresham, OR 97030
Phone (503) 661-2577

1217 NE Burnside Rd
Ste 701
Gresham, OR 97030
Phone (503) 407-1239

10117 SE Sunnyside Rd
Ste F
Happy Valley, OR 97015

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1154304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750723200000",
    "number": "1124033618",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10117 SE SUNNYSIDE RD",
            "address_2": "SUITE F, BOX 1217",
            "city": "CLACKAMAS",
            "state": "OR",
            "postal_code": "970157708",
            "telephone_number": "503-740-1971",
            "fax_number": "503-771-2436"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9123 SE SAINT HELENS ST STE 100F",
            "city": "CLACKAMAS",
            "state": "OR",
            "postal_code": "970156800",
            "telephone_number": "503-740-1971",
            "fax_number": "503-771-2436"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRUMMENACKER",
        "first_name": "MICHELLE",
        "middle_name": "L",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-31",
        "last_updated": "2025-06-24",
        "certification_date": "2025-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OR",
            "license": "98-07-34",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "L3197",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clackamas, OR

Sources for this page

Verify at the official NPI Registry.