Active NPI
Kevin William Janer, PH.D.
- Clinical Psychologist
- Portland, OR
National Provider Identifier
1720131717
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 3191
- Practice address
- 3720 SW 12TH Ave Apt 13
Portland, OR 97239-2945 - Phone
- (503) 862-6882
- NPI assigned
- Jan 21, 2007
- 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 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Neuropsychologist | 103G00000X | 2976 | GA | |
| Clinical Neuropsychologist | 103G00000X | 3191 | OR | |
| Clinical Psychologist | 103TC0700X | 2976 | GA | |
| Clinical Psychologist | 103TC0700X | 3191 | OR | Primary |
Addresses
Primary practice location
3720 SW 12TH Ave Apt 13
Portland, OR 97239-2945
Mailing address
3720 SW 12TH Ave Apt 13
Portland, OR 97239-2945
Phone (503) 862-6882
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jul 1, 2023 through Jul 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3191 | OR | MD | Clinical Psychologist |
| 2976 | GA | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169337600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1782950400000",
"number": "1720131717",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3720 SW 12TH AVE APT 13",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972392945",
"telephone_number": "503-862-6882"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3720 SW 12TH AVE APT 13",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972392945",
"telephone_number": "503-862-6882"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JANER",
"first_name": "KEVIN",
"middle_name": "WILLIAM",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-21",
"last_updated": "2026-07-02",
"certification_date": "2026-07-02",
"status": "A"
},
"taxonomies": [
{
"code": "103G00000X",
"taxonomy_group": "",
"desc": "Clinical Neuropsychologist",
"state": "GA",
"license": "2976",
"primary": false
},
{
"code": "103G00000X",
"taxonomy_group": "",
"desc": "Clinical Neuropsychologist",
"state": "OR",
"license": "3191",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "GA",
"license": "2976",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "OR",
"license": "3191",
"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 Jul 2, 2026; 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.