Active NPI
Kimberly Hazen
- School Psychologist
- Roseburg, OR
National Provider Identifier
1144162686
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Psychologist
- License
- 142037
- Practice address
- 1409 NE Diamond Lake Blvd
Roseburg, OR 97470-3347 - Phone
- (541) 440-4777
- NPI assigned
- Apr 6, 2026
- Last updated
- Apr 6, 2026
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| School Psychologist | 103TS0200X | 142037 | OR | Primary |
Addresses
Primary practice location
1409 NE Diamond Lake Blvd
Roseburg, OR 97470-3347
Mailing address
2336 Richardson Rd
Myrtle Creek, OR 97457-9752
Phone (541) 604-9475
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 142037 | OR | MD | School Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1775433600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1775433600000",
"number": "1144162686",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2336 RICHARDSON RD",
"city": "MYRTLE CREEK",
"state": "OR",
"postal_code": "974579752",
"telephone_number": "541-604-9475"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1409 NE DIAMOND LAKE BLVD",
"city": "ROSEBURG",
"state": "OR",
"postal_code": "974703347",
"telephone_number": "541-440-4777"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAZEN",
"first_name": "KIMBERLY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2026-04-06",
"last_updated": "2026-04-06",
"certification_date": "2026-04-06",
"status": "A"
},
"taxonomies": [
{
"code": "103TS0200X",
"taxonomy_group": "",
"desc": "Psychologist, School",
"state": "OR",
"license": "142037",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Roseburg, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.