Active NPI
Kevin Frederick Mallon, PH.D.
- Health Psychologist
- Hillsboro, OR
National Provider Identifier
1417930009
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Health Psychologist
- License
- PSY 13735
- Practice address
- 1925 NW Amberglen Pkwy
Suite 300
Hillsboro, OR 97006-6945 - Phone
- (503) 906-5019
- Fax
- (503) 906-5193
- NPI assigned
- Nov 28, 2005
- 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 |
|---|---|---|---|---|
| Clinical Neuropsychologist | 103G00000X | PSY13735 | CA | |
| Clinical Psychologist | 103TC0700X | PSY13735 | CA | |
| Health Psychologist | 103TH0004X | PSY 13735 | CA | Primary |
Addresses
Primary practice location
1925 NW Amberglen Pkwy
Suite 300
Hillsboro, OR 97006-6945
Mailing address
PO Box 1034
(Portland Vamc - Hills Cboc)
Portland, OR 97207-1034
Phone (503) 906-5019
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
| License | State | Type | Specialty |
|---|---|---|---|
| PSY13735 | CA | MD | Clinical Neuropsychologist |
| PSY 13735 | CA | MD | Health Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1133136000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1258934400000",
"number": "1417930009",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1034",
"address_2": "(PORTLAND VAMC - HILLS CBOC)",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972071034",
"telephone_number": "503-906-5019",
"fax_number": "503-906-5193"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1925 NW AMBERGLEN PKWY",
"address_2": "SUITE 300",
"city": "HILLSBORO",
"state": "OR",
"postal_code": "970066945",
"telephone_number": "503-906-5019",
"fax_number": "503-906-5193"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MALLON",
"first_name": "KEVIN",
"middle_name": "FREDERICK",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-11-28",
"last_updated": "2009-11-23",
"status": "A"
},
"taxonomies": [
{
"code": "103G00000X",
"taxonomy_group": "",
"desc": "Clinical Neuropsychologist",
"state": "CA",
"license": "PSY13735",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY13735",
"primary": false
},
{
"code": "103TH0004X",
"taxonomy_group": "",
"desc": "Psychologist, Health",
"state": "CA",
"license": "PSY 13735",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hillsboro, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.