Unknown Individual – Clinical Psychologist, NPI 1093783144

Unknown Individual is a healthcare provider. based in Salem, Oregon. specializing in Clinical Psychologist. They hold a License No. 273 (OR). The NPI Number for Unknown Individual is 1093783144

Main info

Organization
Inactive
57 Years Of Experience
Name
Unknown Individual
NPI
1093783144
Phone
(503) 399-7092
Address
1307 COMMERCIAL ST SE
Deactivation Date
7 August 2024

Doctor Profile

Medical School Name
OTHER
Secondary Phone
-
Graduation Year
1969 (57 years ago)
PAC ID
4789865221
Professional Enrollment ID
I20110216001111
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 1307, Commercial Street Southeast, South Salem, Salem, Marion County, Oregon, 97302, United States

    SALEM, OR 97302

    Phone: (503) 399-7092

    Fax: (503) 588-9493

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

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Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 97302)

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Reviews

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Frequently asked questions

Can I verify Unknown Individual with an NPI only?
You can start verification with NPI 1093783144 for Unknown Individual, then check state licensing separately.
Is Unknown Individual excluded from programs when inactive?
The public NPI listing for Unknown Individual is not currently active; confirm directly with the practice or licensing boards.
What healthcare role does Unknown Individual hold?
Scheduling teams often label Unknown Individual under Clinical Psychologist. Clinical services aligned with this taxonomy classification.
Where is Unknown Individual based?
Unknown Individual is tied to Salem, Oregon in the data we show; additional addresses may exist on the full record.
Why does Unknown Individual have multiple addresses?
2 practice locations appear in the available data. Multiple addresses are common for hospital privileges, telehealth, or multi-site groups.

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