Individual provider Active NPI

Jennifer Ann Shaver, PH.D.

  • Clinical Psychologist
  • Portland, OR
National Provider Identifier
1134995186
Registry record updated May 19, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PY60629123 Issued in WA
Practice address
5100 S Macadam Ave Ste 350
Portland, OR 97239-3877
Phone
(503) 231-7854
NPI assigned
Nov 30, 2023
Last updated
May 19, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 19, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PSY-2189 HI
Clinical Psychologist 103TC0700X 40276 TX
Clinical Psychologist 103TC0700X PY60629123 WA Primary

Addresses

Primary practice location

5100 S Macadam Ave Ste 350
Portland, OR 97239-3877

Mailing address

5100 S Macadam Ave Ste 350
Portland, OR 97239-3877
Phone (503) 231-7854

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Opted out of Medicare
Yes, effective Apr 1, 2024 through Apr 1, 2028

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
PSY-2189HIMDClinical Psychologist
40276TXMDClinical Psychologist
PY60629123WAMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Portland DBT Institute, Inc. PastSince Dec 10, 2023 Accepting new patients

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1701302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1779148800000",
    "number": "1134995186",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5100 S MACADAM AVE STE 350",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972393877",
            "telephone_number": "503-231-7854"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5100 S MACADAM AVE STE 350",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972393877",
            "telephone_number": "503-231-7854"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAVER",
        "first_name": "JENNIFER",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-11-30",
        "last_updated": "2026-05-19",
        "certification_date": "2026-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "HI",
            "license": "PSY-2189",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "TX",
            "license": "40276",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WA",
            "license": "PY60629123",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.