Individual provider Active NPI

Kristin Valerius, PHD

  • Clinical Child & Adolescent Psychologist
  • West Linn, OR
National Provider Identifier
1346439783
Registry record updated Jan 26, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X
License
1833 Issued in OR
Practice address
21900 Willamette Dr Ste 202
West Linn, OR 97068-3284
Phone
(503) 653-0631
Fax
(503) 653-1464
NPI assigned
Oct 22, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Child & Adolescent Psychologist 103TC2200X 1833 OR Primary

Addresses

Primary practice location

21900 Willamette Dr Ste 202
West Linn, OR 97068-3284

Mailing address

21900 Willamette Dr Ste 202
West Linn, OR 97068-3284
Phone (503) 653-0631

Other practice location 1

8440 SE Sunnybrook Blvd
Ste 120
Clackamas, OR 97015-5780
Phone (503) 653-0631

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
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
1833ORMDClinical Child & Adolescent Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Sundstrom Clinical Services LLC CurrentSince Oct 1, 2004 Accepting new patients

Locations

8440 SE Sunnybrook Blvd
Ste 120
Clackamas, OR 97015
Phone (503) 653-0631

21900 Willamette Dr
Ste 202
West Linn, OR 97068
Phone (503) 653-0631

Interoperability endpoints

  • Direct secure messaging: kristin.valerius.1@32989.direct.athenahealth.com

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.

NPI Registry JSON

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

{
    "created_epoch": "1193011200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1516924800000",
    "number": "1346439783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21900 WILLAMETTE DR STE 202",
            "city": "WEST LINN",
            "state": "OR",
            "postal_code": "970683284",
            "telephone_number": "503-653-0631",
            "fax_number": "503-653-1464"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21900 WILLAMETTE DR STE 202",
            "city": "WEST LINN",
            "state": "OR",
            "postal_code": "970683284",
            "telephone_number": "503-653-0631",
            "fax_number": "503-653-1464"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8440 SE Sunnybrook Blvd",
            "address_2": "Ste 120",
            "address_purpose": "LOCATION",
            "city": "Clackamas",
            "state": "OR",
            "postal_code": "970155780",
            "country_code": "US",
            "telephone_number": "503-653-0631",
            "fax_number": "503-653-1464",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VALERIUS",
        "first_name": "KRISTIN",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-10-22",
        "last_updated": "2018-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "OR",
            "license": "1833",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Linn, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.