Shane D Kennington, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

L7078 Issued in OR

Practice address

1750 SW Skyline Blvd Ste 206
Portland, OR 97221-2545

Phone

(503) 327-5584

Fax

(971) 351-6851

NPI assigned

Aug 4, 2009

Sex

Male

Sole proprietor

Yes

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

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

Specialty

Clinical Social Worker

Education

Other, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Darelivethrive, LLC

  • Clinical Social Worker
  • Portland, OR
  • NPI 1861940306
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1249344000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697155200000",
    "number": "1174754493",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1750 SW SKYLINE BLVD STE 206",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972212545",
            "telephone_number": "503-327-5584",
            "fax_number": "971-351-6851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1750 SW SKYLINE BLVD STE 206",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972212545",
            "telephone_number": "503-327-5584",
            "fax_number": "971-351-6851"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNINGTON",
        "first_name": "SHANE",
        "middle_name": "D",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-08-04",
        "last_updated": "2023-10-13",
        "certification_date": "2023-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "L7078",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kailin Kenney
• Karee Kenney, M.S.P.T.
• McCrae Nathanial Kenney
• Philip Simmons Kenney, MS LPC
• Erin Alyssa Kenning, L.AC.
• Maureen Elizabeth Kenny
• Adam Kennybrew
• Glen Alan Kenoski, ARNP
• Sharon Jean Kenoski, FNP
• Catherine Lily Meeker Kent

• Clinical Social Worker in Portland, OR
• Providers in Portland, OR by specialty
• Clinical Social Worker in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.