Kerry A. Cannon, MSW, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

80395 Issued in CA

Practice address

1577 Pennsylvania CT
Coos Bay, OR 97420-9203

Phone

(323) 798-7413

Fax

(833) 419-0181

NPI assigned

Nov 10, 2008

Last updated

Jun 20, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Ms. Kerry A. Payton Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Samantha Markman LMFT Inc.

  • Marriage & Family Therapist
  • Newhall, CA
  • NPI 1558925800
  NPD (past)

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

{
    "created_epoch": "1226275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687219200000",
    "number": "1346494978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1577 PENNSYLVANIA CT",
            "city": "COOS BAY",
            "state": "OR",
            "postal_code": "974209203",
            "telephone_number": "209-592-0009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1577 PENNSYLVANIA CT",
            "city": "COOS BAY",
            "state": "OR",
            "postal_code": "974209203",
            "telephone_number": "323-798-7413",
            "fax_number": "833-419-0181"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANNON",
        "first_name": "KERRY",
        "middle_name": "A.",
        "name_prefix": "Ms.",
        "credential": "MSW, LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-11-10",
        "last_updated": "2023-06-20",
        "certification_date": "2023-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "80395",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KERRY",
            "last_name": "PAYTON",
            "middle_name": "A.",
            "prefix": "MS.",
            "credential": "BLS, LPHA, MSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Calvin E. Mang, DCPC
• Evan Campbell, D.M.D.
• Sarah Beth Campbell, LCSW
• Kirsten Canaday
• Donald M. Canavan, N.D.
• Steven Cannon, DDS
• Daniel Carlson
• Randall Carman
• Dallas Arthur Carter, MD
• Gregory Carver, RPH

• Clinical Social Worker in Coos Bay, OR
• Providers in Coos Bay, OR by specialty
• Clinical Social Worker in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2023; 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.