Active NPI
Kern Alvin Olson, PH.D
- Clinical Psychologist
- Portland, OR
National Provider Identifier
1225133655
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 382
- Practice address
- 2311 NW Northrup St
207
Portland, OR 97210-2994 - Phone
- (503) 705-8727
- NPI assigned
- Sep 13, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 382 | OR | Primary |
Addresses
Primary practice location
2311 NW Northrup St
207
Portland, OR 97210-2994
Mailing address
7805 SW Gearhart Dr
Beaverton, OR 97007-6680
Phone (503) 705-8727
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)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 382 | OR | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Advanced Pain Management Center | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Durable Medical Equipment & Medical Supplies
- Portland, OR
- NPI 1467773663
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158105600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1221436800000",
"number": "1225133655",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7805 SW GEARHART DR",
"city": "BEAVERTON",
"state": "OR",
"postal_code": "970076680",
"telephone_number": "503-705-8727"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2311 NW NORTHRUP ST",
"address_2": "207",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972102994",
"telephone_number": "503-705-8727"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OLSON",
"first_name": "KERN",
"middle_name": "ALVIN",
"credential": "PH.D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-13",
"last_updated": "2008-09-15",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "OR",
"license": "382",
"primary": true
}
],
"identifiers": [],
"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 Sep 15, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.