| Tiffany Kettermann, Llc | |
|
2926 Ne Flanders St Ste 3c Portland OR 97232-3259 | |
| (971) 270-0167 | |
| Not Available |
| Full Name | Tiffany Kettermann, Llc |
|---|---|
| Speciality | Counselor |
| Location | 2926 Ne Flanders St Ste 3c, Portland, Oregon |
| Authorized Official Name and Position | Tiffany Kettermann (CEO) |
| Authorized Official Contact | 9712700167 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tiffany Kettermann, Llc 2926 Ne Flanders St Ste 3c Portland OR 97232-3259 Ph: (360) 931-0390 | Tiffany Kettermann, Llc 2926 Ne Flanders St Ste 3c Portland OR 97232-3259 Ph: (971) 270-0167 |
| NPI Number | 1003461740 |
|---|---|
| Provider Enumeration Date | 08/08/2019 |
| Last Update Date | 08/08/2019 |
| Medicare PECOS PAC ID | 0941685184 |
|---|---|
| Medicare Enrollment ID | O20220923001810 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003461740 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Secondary |
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Melanie Swallow |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1265717292 PECOS PAC ID: 3173888658 Enrollment ID: I20180604002760 |
| Provider Name | Laurie B Fieldman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1225402449 PECOS PAC ID: 9537463237 Enrollment ID: I20220131000937 |
| Provider Name | Stacie M Wentling |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1801021159 PECOS PAC ID: 9830585140 Enrollment ID: I20231229001204 |
| Provider Name | Amy Juliet Schulz |
|---|---|
| Provider Type | Practitioner - Other (non-physician) |
| Provider Identifiers | NPI Number: 1114306818 PECOS PAC ID: 1254781222 Enrollment ID: I20240103002495 |
| Provider Name | Clark Hazel |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1184238024 PECOS PAC ID: 1254782592 Enrollment ID: I20240110004594 |
| Provider Name | April Lynn Nunez |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1972987451 PECOS PAC ID: 3971954116 Enrollment ID: I20240111003365 |
| Provider Name | Katie Krail |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1891296141 PECOS PAC ID: 6305297557 Enrollment ID: I20240111003973 |
| Provider Name | Jill Anne Godici |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1558916460 PECOS PAC ID: 6901257179 Enrollment ID: I20240111004537 |
| Provider Name | Rebecca O'shea |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1295218683 PECOS PAC ID: 0446601611 Enrollment ID: I20240111004559 |
| Provider Name | Jonathan Clarke |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1790323350 PECOS PAC ID: 6901257187 Enrollment ID: I20240111004939 |
| Provider Name | Elise Madline Himes |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1306495833 PECOS PAC ID: 9234580333 Enrollment ID: I20240112000762 |
| Provider Name | Curtis Allen White |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1568017325 PECOS PAC ID: 0143671271 Enrollment ID: I20240112001865 |
| Provider Name | Heather Christin Baucum |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1467975516 PECOS PAC ID: 1557713617 Enrollment ID: I20240115000948 |
| Provider Name | Ruma Marshall |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1376054577 PECOS PAC ID: 8224480959 Enrollment ID: I20240118002392 |
| Provider Name | Shelby Keirn |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1750632741 PECOS PAC ID: 9931551108 Enrollment ID: I20240123004968 |
| Provider Name | Leisha Miller |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1740603356 PECOS PAC ID: 1658724638 Enrollment ID: I20240125003101 |
| Provider Name | Michelle Jeanne Bernett |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1205025103 PECOS PAC ID: 0143673038 Enrollment ID: I20240126002464 |
| Provider Name | Tiffany Kettermann |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1194067355 PECOS PAC ID: 8123403375 Enrollment ID: I20240126003248 |
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