Active NPI
Scott A Ketaineck, PSYD
- Clinical Psychologist
- Salem, OR
National Provider Identifier
1366639536
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 2373
- Practice address
- 2600 Center St NE
Salem, OR 97301-2669 - Phone
- (503) 947-2863
- NPI assigned
- Oct 1, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | |||
| Behavior Analyst | 103K00000X | |||
| Clinical Psychologist | 103TC0700X | 2373 | OR | Primary |
Addresses
Primary practice location
2600 Center St NE
Salem, OR 97301-2669
Mailing address
2600 Center St NE
Salem, OR 97301-2669
Phone (503) 947-2863
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1191196800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1407196800000",
"number": "1366639536",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2600 CENTER ST NE",
"city": "SALEM",
"state": "OR",
"postal_code": "973012669",
"telephone_number": "503-947-2863"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2600 CENTER ST NE",
"city": "SALEM",
"state": "OR",
"postal_code": "973012669",
"telephone_number": "503-947-2863"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KETAINECK",
"first_name": "SCOTT",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-10-01",
"last_updated": "2014-08-05",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": null,
"license": null,
"primary": false
},
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": null,
"license": null,
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "OR",
"license": "2373",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Salem, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.