Active NPI
Kordell Noltan Kennemer, PSYD
- Clinical Psychologist
- Oregon City, OR
National Provider Identifier
1730282138
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 1633
- Practice address
- 619 Madison St Ste 108
Oregon City, OR 97045 - Phone
- (503) 387-3957
- NPI assigned
- Sep 7, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 1633 | OR | Primary |
Addresses
Primary practice location
619 Madison St Ste 108
Oregon City, OR 97045
Mailing address
PO Box 14900
DHS Ofs Irs Dba Oregon State Hospital
Salem, OR 97309-5016
Phone (503) 945-9840
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1633 | OR | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kennemer & Smith Psychological Services LLC | Clinical | Current | Accepting new patients |
Locations
619 Madison St
Ste 108
Oregon City, OR 97045
Phone (503) 303-4257
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Clinical Psychologist
- Oregon City, OR
- NPI 1962004358
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157587200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1605484800000",
"number": "1730282138",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 14900",
"address_2": "DHS OFS IRS DBA OREGON STATE HOSPITAL",
"city": "SALEM",
"state": "OR",
"postal_code": "973095016",
"telephone_number": "503-945-9840"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "619 MADISON ST STE 108",
"city": "OREGON CITY",
"state": "OR",
"postal_code": "97045",
"telephone_number": "503-387-3957"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KENNEMER",
"first_name": "KORDELL",
"middle_name": "NOLTAN",
"credential": "PSYD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-07",
"last_updated": "2020-11-16",
"certification_date": "2020-11-16",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "OR",
"license": "1633",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oregon City, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.