Active NPI
Kathryn Elyse Woicicki, PSY.D.
- Psychologist
- Portland, OR
National Provider Identifier
1679809065
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 3784
- Practice address
- 3700 N Williams Ave
Portland, OR 97227-1441 - Phone
- (503) 281-4852
- NPI assigned
- Oct 20, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | |||
| Clinical Psychologist | 103TC0700X | 30399 | CA | |
| Psychologist | 103T00000X | 3784 | OR | Primary |
Addresses
Primary practice location
3700 N Williams Ave
Portland, OR 97227-1441
Mailing address
3700 N Williams Ave
Portland, OR 97227-1441
Phone (503) 281-4852
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| TBD | Other | OR | OHP |
| C653953 | Other | OR | OREGON DMV |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Feb 18, 2025 through Feb 18, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3784 | OR | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1255996800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1727222400000",
"number": "1679809065",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3700 N WILLIAMS AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972271441",
"telephone_number": "503-281-4852"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3700 N WILLIAMS AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972271441",
"telephone_number": "503-281-4852"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WOICICKI",
"first_name": "KATHRYN",
"middle_name": "ELYSE",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-10-20",
"last_updated": "2024-09-25",
"certification_date": "2024-09-25",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "30399",
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "OR",
"license": "3784",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OHP",
"identifier": "TBD",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OREGON DMV",
"identifier": "C653953",
"state": "OR"
}
],
"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 Sep 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.