Kimberly Rideout

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

2367 Issued in OR

Practice address

5200 SW Macadam Ave Ste 580
Portland, OR 97239-3837

Phone

(503) 231-7854

NPI assigned

Oct 9, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1191888000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1541548800000",
    "number": "1720276363",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 SW MACADAM AVE STE 580",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972393837",
            "telephone_number": "503-231-7854"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5200 SW MACADAM AVE STE 580",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972393837",
            "telephone_number": "503-231-7854"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2330 NE Siskiyou St",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972122471",
            "country_code": "US",
            "telephone_number": "502-528-0757",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RIDEOUT",
        "first_name": "KIMBERLY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-10-09",
        "last_updated": "2018-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "OR",
            "license": "2367",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Betty Riddle
• Emily Justusson Riddle, MD
• Joy Riddle
• Lauren Riddle
• Ride Connection, Inc.
• Lucy Rideout, FNP
• Isaac Rider, MS, LPC
• Clayton Ridner
• Andrea Rieck
• Kurt Rieck

• Clinical Psychologist in Portland, OR
• Providers in Portland, OR by specialty
• Clinical Psychologist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2018; 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.