NPIMap

Organization Active NPI

Jennifer Stock, PH.D., P.C.

  • Psychologist
  • Portland, OR
National Provider Identifier
1417080979
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
1047 Issued in OR
Legal business name
JENNIFER STOCK, PH.D., P.C.
Practice address
833 SW 11TH Ave
Suite 220
Portland, OR 97205-2125
Phone
(503) 242-1558
NPI assigned
Mar 13, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Jennifer Gayle Stock, PH.D.
Title
President
Phone
(503) 242-1558

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103T00000X 1047 OR Primary

Addresses

Primary practice location

833 SW 11TH Ave
Suite 220
Portland, OR 97205-2125

Mailing address

833 SW 11TH Ave
Suite 220
Portland, OR 97205-2125
Phone (503) 242-1558

National Provider Directory

National Provider Directory

Locations

833 SW 11th Ave
Ste 220
Portland, OR 97205
Phone (503) 242-1558

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1173744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1417080979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "833 SW 11TH AVE",
            "address_2": "SUITE 220",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972052125",
            "telephone_number": "503-242-1558"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "833 SW 11TH AVE",
            "address_2": "SUITE 220",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972052125",
            "telephone_number": "503-242-1558"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JENNIFER STOCK, PH.D., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "STOCK",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "GAYLE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "503-242-1558",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": "OR",
            "license": "1047",
            "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 Aug 22, 2020; 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.