Kimberly A Conrow, MA, LPC, CADC-1

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

C2131 Issued in OR

Practice address

818 NW 17TH Ave
Suite 1
Portland, OR 97209-2327

Phone

(503) 248-0011

Fax

(503) 233-3883

NPI assigned

Feb 2, 2007

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

• Mrs. Kimberly A Walen Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jan 1, 2024 through Jan 1, 2028

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

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

{
    "created_epoch": "1170374400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1407715200000",
    "number": "1497893143",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1552 N SIMPSON ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972174653",
            "telephone_number": "503-422-1789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "818 NW 17TH AVE",
            "address_2": "SUITE 1",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972092327",
            "telephone_number": "503-248-0011",
            "fax_number": "503-233-3883"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONROW",
        "first_name": "KIMBERLY",
        "middle_name": "A",
        "name_prefix": "Ms.",
        "credential": "MA, LPC,  CADC-1",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-02",
        "last_updated": "2014-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OR",
            "license": "C2131",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "WALEN",
            "middle_name": "A",
            "prefix": "MRS.",
            "credential": "MA, CADC I",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Shannon Conrad, L.AC
• Suki Katheryn Conrad, MD
• Carol Ray Conrades, PT
• Christopher Conrady, CPNP
• Jesus Ernesto Conrique Garcia
• Alisha Rose Conroy
• Andrea Conroy
• Jocelyn Conroy, MD
• John Conroy, M.D.
• Kerrins Thomas Conroy III, NCC, LPC

• Professional Counselor in Portland, OR
• Providers in Portland, OR by specialty
• Professional Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.