Active NPI
Walter Winfree
- Clinical Psychologist
- Portland, OR
National Provider Identifier
1578073375
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 2835
- Practice address
- 3710 SW US Veterans Hospital Rd # P3Mhdc
Portland, OR 97239-2964 - Phone
- (405) 641-0106
- NPI assigned
- Oct 5, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 2835 | OR | Primary |
Addresses
Primary practice location
3710 SW US Veterans Hospital Rd # P3Mhdc
Portland, OR 97239-2964
Mailing address
4134 N Michigan Ave
Portland, OR 97217-3115
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2835 | OR | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1507161600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1507161600000",
"number": "1578073375",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4134 N MICHIGAN AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972173115"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3710 SW US VETERANS HOSPITAL RD # P3MHDC",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972392964",
"telephone_number": "405-641-0106"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WINFREE",
"first_name": "WALTER",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-10-05",
"last_updated": "2017-10-05",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "OR",
"license": "2835",
"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 Oct 5, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.