Active NPI
Jennell Roden
- Professional Counselor
- Portland, OR
National Provider Identifier
1376401943
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- R12591
- Practice address
- 3611 SE 20TH Ave Ste 202
Portland, OR 97202-2967 - Phone
- (503) 334-3035
- NPI assigned
- Jan 13, 2026
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | R12591 | OR | Primary |
Addresses
Primary practice location
3611 SE 20TH Ave Ste 202
Portland, OR 97202-2967
Mailing address
16333 SE Dagmar Rd
Portland, OR 97267-6356
Phone (503) 753-6842
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R12591 | OR | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Psychological Services Connection LLC | Professional | 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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1768262400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1768262400000",
"number": "1376401943",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16333 SE DAGMAR RD",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972676356",
"telephone_number": "503-753-6842"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3611 SE 20TH AVE STE 202",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972022967",
"telephone_number": "503-334-3035"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RODEN",
"first_name": "JENNELL",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2026-01-13",
"last_updated": "2026-01-13",
"certification_date": "2026-01-13",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "OR",
"license": "R12591",
"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 Jan 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.