Kenneth Mark Derby, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

2204 Issued in WA

Practice address

1124 E 35TH Ave
Spokane, WA 99203-3168

Phone

(509) 747-7460

Fax

(509) 323-5965

NPI assigned

Feb 2, 2007

Last updated

Sep 11, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Credentials

Doctor of Philosophy

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": "1757548800000",
    "number": "1679611420",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1124 E 35TH AVE",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992033168",
            "telephone_number": "509-747-7460",
            "fax_number": "509-323-5965"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1124 E 35TH AVE",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992033168",
            "telephone_number": "509-747-7460",
            "fax_number": "509-323-5965"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERBY",
        "first_name": "KENNETH",
        "middle_name": "MARK",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-02",
        "last_updated": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "WA",
            "license": "2204",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WA",
            "license": "2204",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kimberly Deppisch, DO
• Richard James Deppisch II, DO
• Dawn Marie Depriest, FNP-C
• Depth Psychology Services, LLC (Ward Robak, PhD)
• Melissa Derbecker
• Lynn Dee Derby, M.D.
• Mary M Derby
• Paul Derenzo, LMHCA
• Derive Family Therapy
• Laura Derleth, PT

• Clinical Psychologist in Spokane, WA
• Providers in Spokane, WA by specialty
• Clinical Psychologist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 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.