Active NPI
John Jennings, CADC II
- Addiction (Substance Use Disorder) Counselor
- Portland, OR
National Provider Identifier
1770784274
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 11-R-10
- Practice address
- 2415 SE 43Rd Ave
Portland, OR 97206-1600 - Phone
- (503) 230-9654
- NPI assigned
- May 30, 2007
- 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 |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 11-R-10 | OR | Primary |
Addresses
Primary practice location
2415 SE 43Rd Ave
Portland, OR 97206-1600
Mailing address
2425 SW 171St PL
Beaverton, OR 97006-4300
Phone (415) 309-4500
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11-R-10 | OR | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1180483200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1306800000000",
"number": "1770784274",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2425 SW 171ST PL",
"city": "BEAVERTON",
"state": "OR",
"postal_code": "970064300",
"telephone_number": "415-309-4500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2415 SE 43RD AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972061600",
"telephone_number": "503-230-9654"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JENNINGS",
"first_name": "JOHN",
"credential": "CADC II",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-30",
"last_updated": "2011-05-31",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "OR",
"license": "11-R-10",
"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 May 31, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.