Unknown Individual – Clinical Social Worker, NPI 1821065939

Clinical Social Worker

Unknown Individual is a healthcare provider. based in Oregon city, Oregon. specializing in Clinical Social Worker. They hold a License No. L1640 (OR). The NPI Number for Unknown Individual is 1821065939

Main info

Organization

Inactive

38 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1821065939

Phone

(503) 742-5300

Address

2051 KAEN RD

Deactivation Date

24 May 2023

Doctor Profile

Medical School Name

OTHER

Secondary Phone

5036558401

Graduation Year

1988 (38 years ago)

PAC ID

1456543164

Group Practice PAC ID

9537065560

Professional Enrollment ID

I20101012001321

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

Clackamas County Veterans Services, 2051, Kaen Road, Mount Pleasant, Oregon City, Metro, Clackamas County, Oregon, 97045, United States
SUITE 398
OREGON CITY, OR 970454088
Phone: (503) 742-5300
Fax: (503) 742-5301
Type: Mailing
Proctor Boulevard, Sandy, Clackamas County, Oregon, 97055, United States
SANDY, OR 970558035
Phone: (503) 722-6950
Fax: (503) 722-6939
Type: Location

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.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

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 97045)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.

PAC ID: 9537065560View full group profile

Name	Specialty	State
MELANIE BERTENELLI (MD)	Family Practice	OR
REBEKAH POTTS	Clinical Social Worker	OR
MATTHEW P AZAR (LCSW)	Clinical Social Worker	OR
SUZANNE LAPIDUS	Clinical Social Worker	OR
MRS. JENNIFER MOON (NP)	Nurse Practitioner	OR
MARK B. HARSHFIELD (PMHNP)	-	OR
KAREN CARPENTER (LCSW)	Clinical Social Worker	OR
MISS KATHRYN ANN WHIPPLE	Clinical Social Worker	OR
MS. SUSAN DE TARR (M.S.W., CADC 1)	-	OR
CHRISTOPHER J ROBB (LCSW)	Clinical Social Worker	OR

Reviews

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Frequently asked questions

Can I cross-check Unknown Individual using NPI 1821065939?

NPI 1821065939 belongs to Unknown Individual; compare other details if you need extra assurance.

Who updates status for Unknown Individual?

NPPES shows Unknown Individual as inactive; dates on the record explain the timeline when available.

What area of care is associated with Unknown Individual?

Unknown Individual's record emphasizes Clinical Social Worker. Clinical services aligned with this taxonomy classification.

What practice footprint exists for Unknown Individual?

Travel planning: use Oregon City, Oregon as the reference point for Unknown Individual, then confirm.

When was this NPI issued?

Enumeration for Unknown Individual is noted as not shown in this record where the registry provides it.