Kenneth Eatmon, LLP

Primary specialty

PsychologistTaxonomy code 103T00000X

License

6361004219 Issued in MI

Practice address

5728 Woodland VW
Clarkston, MI 48346-2637

Phone

(312) 933-1459

NPI assigned

Mar 6, 2014

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Richard Kneip, PH.D., P.C.

  • Community/Behavioral Health Agency
  • Clarkston, MI
  • NPI 1679739700
  NPD (past)
• Ryan Janis PSYD Inc

  • Psychologist
  • Los Angeles, CA
  • NPI 1487102570
  NPD (past)

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

{
    "created_epoch": "1394064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739836800000",
    "number": "1548686124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5728 WOODLAND VW",
            "city": "CLARKSTON",
            "state": "MI",
            "postal_code": "483462637",
            "telephone_number": "312-933-1459"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5728 WOODLAND VW",
            "city": "CLARKSTON",
            "state": "MI",
            "postal_code": "483462637",
            "telephone_number": "312-933-1459"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "617 S Olive St Ste 200",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900141646",
            "country_code": "US",
            "telephone_number": "213-430-9080",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EATMON",
        "first_name": "KENNETH",
        "credential": "LLP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-03-06",
        "last_updated": "2025-02-18",
        "certification_date": "2025-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TF0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Forensic",
            "state": "MI",
            "license": "6361004219",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MI",
            "license": "6361004219",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thomas Duty
• Heather Dyson
• Sydney Dziurman
• Easterseals Morc Health Care, Inc.
• Wendy Eastman
• Ed Fahey Associates PC
• Julia Louise Edwards
• Megan Renee Edwards
• Ralph Edwards, MSW
• Wendyliza Edwards, PT

• Psychologist in Clarkston, MI
• Providers in Clarkston, MI by specialty
• Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2025; 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.