Jennifer Anne Simon-Thomas, PH.D.

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

License

2570 Issued in OR

Practice address

4850 SW Scholls Ferry Rd Ste 301
Portland, OR 97225-1696

Phone

(503) 707-0348

Fax

(971) 266-2868

NPI assigned

Feb 16, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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.

• Just Psychological Services, PC

  • Clinical Child & Adolescent Psychologist
  • Portland, OR
  • NPI 1699495804
  NPD Authorized official

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

{
    "created_epoch": "1171584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661731200000",
    "number": "1194869149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5319 SW WESTGATE DR STE 168",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972212430",
            "telephone_number": "503-707-0348",
            "fax_number": "971-266-2868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4850 SW SCHOLLS FERRY RD STE 301",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972251696",
            "telephone_number": "503-707-0348",
            "fax_number": "971-266-2868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIMON-THOMAS",
        "first_name": "JENNIFER",
        "middle_name": "ANNE",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-16",
        "last_updated": "2022-08-29",
        "certification_date": "2020-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MT",
            "license": "355",
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "OR",
            "license": "2570",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Steven M Simmons, DMD
• Troy Wayne Simmons, D.P.M.
• Elinor Simms
• Moises Simon Bartolo
• Mixtly Simon-Beard
• Amanda E. Simon, MD
• Bailey Simon, MD
• Cheri Simon
• Gary Simon Jr.
• Gianna Simon

• Clinical Child & Adolescent Psychologist in Portland, OR
• Providers in Portland, OR by specialty
• Clinical Child & Adolescent Psychologist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.