NPIMap

Organization Active NPI

Mikala L. Saccoman, PHD, LLC

  • Psychologist
  • Bend, OR
National Provider Identifier
1164180683
Registry record updated Dec 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Legal business name
MIKALA L. SACCOMAN, PHD, LLC
Practice address
497 SW Century Dr Ste 104
Bend, OR 97702-1167
Phone
(541) 678-5174
Fax
(541) 678-5017
NPI assigned
Dec 1, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2021

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

Authorized official

Name
Dr. Mikala L Saccoman, PHDNPI 1396014759
Title
Owner
Phone
(541) 678-5174

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical NeuropsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103G00000X
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X Primary

Addresses

Primary practice location

497 SW Century Dr Ste 104
Bend, OR 97702-1167

Mailing address

497 SW Century Dr Ste 104
Bend, OR 97702-1167
Phone (541) 678-5174

Other practice location 1

497 SW Century Dr Ste 102
Bend, OR 97702-1167
Phone (541) 678-5174

National Provider Directory

National Provider Directory

Locations

497 SW Century Dr
Ste 104
Bend, OR 97702
Phone (541) 678-5164

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1638316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1638316800000",
    "number": "1164180683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "497 SW CENTURY DR STE 104",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977021167",
            "telephone_number": "541-678-5174",
            "fax_number": "541-678-5017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "497 SW CENTURY DR STE 104",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977021167",
            "telephone_number": "541-678-5174",
            "fax_number": "541-678-5017"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "497 SW Century Dr Ste 102",
            "address_purpose": "LOCATION",
            "city": "Bend",
            "state": "OR",
            "postal_code": "977021167",
            "country_code": "US",
            "telephone_number": "541-678-5174",
            "fax_number": "541-678-5017",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MIKALA L. SACCOMAN, PHD, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-01",
        "last_updated": "2021-12-01",
        "certification_date": "2021-12-01",
        "status": "A",
        "authorized_official_last_name": "SACCOMAN",
        "authorized_official_first_name": "MIKALA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "541-678-5174",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bend, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2021; 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.