Active NPI
Sharon Rebecca Chatkuptlee, PSYD
- Psychologist
- Portland, OR
National Provider Identifier
1184645871
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 1599
- Practice address
- 5410 SW Macadam Ave
Suite 230
Portland, OR 97239 - Phone
- (503) 719-6519
- Fax
- (503) 719-6529
- NPI assigned
- Jul 21, 2006
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 1599 | OR | Primary |
Addresses
Primary practice location
5410 SW Macadam Ave
Suite 230
Portland, OR 97239
Mailing address
5410 SW Macadam Ave
Suite 230
Portland, OR 97239
Phone (503) 963-1290
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5610238 | Other | CCN | |
| 054123018 | Other | BLUE CROSS |
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 |
|---|---|---|---|
| 1599 | OR | MD | Dental Hygienist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153440000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1275436800000",
"number": "1184645871",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5410 SW MACADAM AVE",
"address_2": "SUITE 230",
"city": "PORTLAND",
"state": "OR",
"postal_code": "97239",
"telephone_number": "503-963-1290",
"fax_number": "503-230-1541"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5410 SW MACADAM AVE",
"address_2": "SUITE 230",
"city": "PORTLAND",
"state": "OR",
"postal_code": "97239",
"telephone_number": "503-719-6519",
"fax_number": "503-719-6529"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHATKUPTLEE",
"first_name": "SHARON",
"middle_name": "REBECCA",
"credential": "PSYD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-07-21",
"last_updated": "2010-06-02",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "OR",
"license": "1599",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CCN",
"identifier": "5610238",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "054123018",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.