Unknown Individual – Child & Adolescent Psychiatry Physician, NPI 1366638553

Unknown Individual is a healthcare provider. based in Salem, Oregon. specializing in Child & Adolescent Psychiatry Physician. They hold a License No. MD12514 (OR). The NPI Number for Unknown Individual is 1366638553

Main info

Organization
Inactive
Name
Unknown Individual
NPI
1366638553
Phone
(503) 399-7083
Address
367 REES HILL RD SE
Deactivation Date
23 August 2021
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

  • Rees Hill Road Southeast, Salem, Marion County, Oregon, 97306, United States

    SALEM, OR 97306

    Phone: (503) 399-7083

    Fax: (503) 399-7083

    Type: Mailing

  • 3995, Marcola Road, Springfield, Lane County, Oregon, 97477, United States

    SPRINGFIELD, OR 97477

    Phone: (541) 726-1465

    Fax: (541) 726-5085

    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.

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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 97306)

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Reviews

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Frequently asked questions

Does Unknown Individual share an NPI with anyone else?
NPI numbers are unique to each provider or organization — Unknown Individual uses 1366638553.
What dates should I check for Unknown Individual's activity?
We display what the registry publishes: Unknown Individual appears inactive there.
What taxonomy line describes Unknown Individual?
For research purposes, treat Unknown Individual as Child & Adolescent Psychiatry Physician in this dataset. Clinical services aligned with this taxonomy classification.
What address line appears for Unknown Individual?
Unknown Individual's geographic hint is Salem, Oregon in our summary view.
What does 'Individual Provider' mean on this profile?
Entity type tells you whether the number belongs to a person or an organization.

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