Kenneth A Shultz, EDD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PY760 Issued in WA

Practice address

7600 NE 41St St
#310
Vancouver, WA 98662-6728

Phone

(360) 567-1665

Fax

(360) 253-3196

NPI assigned

Dec 19, 2007

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

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Oct 1, 2016 through Oct 1, 2026

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1198022400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1198022400000",
    "number": "1285818732",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7600 NE 41ST ST",
            "address_2": "#310",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986626728",
            "telephone_number": "360-567-1665",
            "fax_number": "360-253-3196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7600 NE 41ST ST",
            "address_2": "#310",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986626728",
            "telephone_number": "360-567-1665",
            "fax_number": "360-253-3196"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHULTZ",
        "first_name": "KENNETH",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "EDD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-12-19",
        "last_updated": "2007-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "WA",
            "license": "PY760",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Corrie Renae Shrock, RN
• Jeffrey David Shrock, O.D.
• Jessica Nichole Shuell, DNP FNP
• Harold Shulman, MD
• Michael Edward Shults, LMHC
• Susan K. Shultz, D.C., L.AC.
• Taylor Michele Shultz
• Yelena Shurov, RUSSIAN INTERPRETER
• Allison Karan Shuster, PA-C
• Crystal Rose Shutt, PTA

• Psychologist in Vancouver, WA
• Providers in Vancouver, WA by specialty
• Psychologist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2007; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.