Dale Kereczman, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

L5516 Issued in OR

Practice address

4560 SE International Way Ste 100
Milwaukie, OR 97222-4628

Phone

(503) 929-4945

NPI assigned

Oct 10, 2014

Sex

Male

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": "1412899200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566950400000",
    "number": "1740684331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7480 SW 49TH CT",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972191492",
            "telephone_number": "503-929-4945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4560 SE INTERNATIONAL WAY STE 100",
            "city": "MILWAUKIE",
            "state": "OR",
            "postal_code": "972224628",
            "telephone_number": "503-929-4945"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KERECZMAN",
        "first_name": "DALE",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-10-10",
        "last_updated": "2019-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "L5516",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Kemmerer
• Katy Renee Kemp, DPT
• Allison Kennedy, BA
• Siobhan Melinda Kennedy, L.M.T.
• Lisa M Kensil, PA
• Breanne Ayla Mat Kerlin, RDH, EPDH, BSDH
• Jeremy S Kern
• Debra Jean Kester
• Linda Verlee Ketchersio, PHYSICAL THERAPIST A
• Habtemariam Ketema

• Clinical Social Worker in Milwaukie, OR
• Providers in Milwaukie, OR by specialty
• Clinical Social Worker in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2019; 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.