NPIMap

Organization Active NPI

Kenneth a Shultz Edd PS

  • Psychologist
  • Vancouver, WA
National Provider Identifier
1568444776
Registry record updated Oct 30, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
PSY760 Issued in WA
Legal business name
KENNETH A SHULTZ EDD PS
Practice address
7600 NE 41St St
#310
Vancouver, WA 98662-6728
Phone
(360) 567-1665
Fax
(360) 253-3196
NPI assigned
Nov 15, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2007

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

Authorized official

Name
Dr. Kenneth A Shultz, EDD
Title
President
Phone
(360) 567-1665

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103T00000X PSY760 WA Primary

Addresses

Primary practice location

7600 NE 41St St
#310
Vancouver, WA 98662-6728

Mailing address

7600 NE 41St St
#310
Vancouver, WA 98662-6728
Phone (360) 567-1665

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1132012800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193702400000",
    "number": "1568444776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7600 NE 41ST ST",
            "address_2": "#310",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986626728",
            "telephone_number": "360-567-1665",
            "fax_number": "360-253-3196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7600 NE 41ST ST",
            "address_2": "#310",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986626728",
            "telephone_number": "360-567-1665",
            "fax_number": "360-253-3196"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNETH A SHULTZ EDD PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-15",
        "last_updated": "2007-10-30",
        "status": "A",
        "authorized_official_last_name": "SHULTZ",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "360-567-1665",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "EDD"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": "WA",
            "license": "PSY760",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vancouver, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2007; 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.