Fen Thomas Kacin, PWS

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

License

113107 Issued in OR

Practice address

2410 SE 10TH Ave
Portland, OR 97214-4624

Phone

(503) 383-9643

Fax

(503) 214-5545

NPI assigned

Feb 15, 2025

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Cassandra Sophia Clark Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1739577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739577600000",
    "number": "1609671593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2410 SE 10TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972144624",
            "telephone_number": "503-383-9643",
            "fax_number": "503-214-5545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2410 SE 10TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972144624",
            "telephone_number": "503-383-9643",
            "fax_number": "503-214-5545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KACIN",
        "first_name": "FEN",
        "middle_name": "THOMAS",
        "credential": "PWS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-02-15",
        "last_updated": "2025-02-15",
        "certification_date": "2025-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "OR",
            "license": "113107",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CASSANDRA",
            "last_name": "CLARK",
            "middle_name": "SOPHIA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Stephanie Kaatz, RD
• Sita Kaba
• Maxine Rachel Kacher, CCC-SLP
• Andrea Kachman, PNP
• Alison Kachuck, PHARMD
• Ebony Kaczorowski
• Kadalyst Health Partners, LLC
• Kalei Renae Kadau, R.N.
• Hannah J Kadavy, MD
• Timothy Kaddis, MD

• Peer Specialist in Portland, OR
• Providers in Portland, OR by specialty
• Peer Specialist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 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.