JACK KEENAN (NPI# 1649641812) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1649641812 |
| Entity Type | Individual |
| Full Name | JACK KEENAN |
| Practice Address |
3530 Se 136th Ave Apt 5 Portland OR 97236-2958 |
| Mailing Address |
3587 Heathrow Way Medford OR 97504-4004 |
| Practice Telephone | 5037194535 |
| Practice Fax Number | 5037194537 |
| Mailing Telephone | 3474062922 |
| Enumeration Date | 2015-10-14 |
| Last Update Date | 2016-02-18 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YM0800X |
Counselor Specialization: Mental Health |
Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811343650 | Jack B Keenan | Student in an Organized Health Care Education/Training Program | 2601 E Roosevelt St, Phoenix, AZ 85008-4973 | 2016-05-11 |
| Street Address |
3530 SE 136TH AVE APT 5 |
| City | PORTLAND |
| State | OR |
| Zip Code | 97236-2958 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528466281 | Matthew Pepitone | Counselor | 3530 Se 136th Ave Apt 5, Portland, OR 97236-2958 | 2014-12-11 |
| 1497204812 | Carissa Burkett | Counselor | 3530 Se 136th Ave Apt 5, Portland, OR 97236-2958 | 2016-09-27 |
| 1427503002 | Elizabeth Aguon | Counselor | 3530 Se 136th Ave Apt 5, Portland, OR 97236-2958 | 2016-08-24 |
| 1447617634 | Michael Hodges | Counselor | 3530 Se 136th Ave Apt 5, Portland, OR 97236-2958 | 2016-01-20 |
| 1609248905 | John Chaplow | Counselor | 3530 Se 136th Ave Apt 5, Portland, OR 97236-2958 | 2015-10-26 |
| 1922482116 | Byron Galloway | Counselor | 3530 Se 136th Ave Apt 5, Portland, OR 97236-2958 | 2015-07-17 |
| 1386028579 | Violet Kawano | Social Worker | 3530 Se 136th Ave Apt 5, Portland, OR 97236-2958 | 2015-07-17 |
| 1629467527 | Rita Penkin | Social Worker | 3530 Se 136th Ave Apt 5, Portland, OR 97236-2958 | 2015-01-15 |
| 1538558432 | Amanda Glatter | Social Worker | 3530 Se 136th Ave Apt 5, Portland, OR 97236-2958 | 2015-01-15 |
| 1306244082 | Charles Mercier | Social Worker | 3530 Se 136th Ave Apt 5, Portland, OR 97236-2958 | 2014-12-12 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336650357 | Wondmimu Edao Chako | Registered Nurse | 3708 Se 144th Avenue, Portland, OR 97236 | 2017-10-17 |
| 1881142388 | John Ho | Pharmacist | 14700 Se Division St., Portland, OR 97236 | 2016-09-14 |
| 1306392527 | Lori-ann Lima | Nurse Practitioner | Multnomah County Health Department- Mid Cty Health Ctr, 12710 Se Division St, Portland, OR 97236 | 2016-08-28 |
| 1982096202 | Allan Fitzpatrick Beals-gibson | Adult Companion | 15602 Se Division St., Portland, OR 97236 | 2015-02-24 |
| 1386047132 | Columbiacare Services | Community Based Residential Treatment Facility, Mental Illness | 3530 Se 136th Ave. #5, Portland, OR 97236 | 2014-10-07 |
| 1356750319 | Kendra Harding | Counselor | 17214 Se Division Street, Portland, OR 97236 | 2014-08-04 |
| 1659790400 | Nghia Tran | Pharmacist | 8438 Se 138th Dr, Portland, OR 97236 | 2014-04-09 |
| 1942623764 | Laurel Katherine Hallock Koppelman | Nurse Practitioner | 12720 Se Division Street, Portland, OR 97236 | 2014-01-30 |
| 1982046249 | Victoria D Lathrop | Massage Therapist | 17221 Se Divistion St S-21, Portland, OR 97236 | 2013-07-26 |
| 1669819694 | Ariann Von Vaughn | Dental Hygienist | 18011 Se Pershing Ct, Portland, OR 97236 | 2013-05-31 |
| Find all providers in zip 97236 | ||||
| Taxonomy Code | 101YM0800X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336748243 | Jessica M Feinsmith | Counselor | 6530 N Williams Ave, Portland, OR 97217-1924 | 2020-10-21 |
| 1720687809 | Karissa Myriah Gregory | Counselor | 14255 Se Rupert Dr, Portland, OR 97267-1211 | 2020-10-20 |
| 1528667904 | Zuzana Sakova | Counselor | 819 Se Morrison St Ste 225, Portland, OR 97214-6311 | 2020-10-18 |
| 1891302238 | Nina Landey | Counselor | 120 Se 53rd Ave, Portland, OR 97215-1204 | 2020-09-29 |
| 1902412166 | Peter H Addy LLC | Counselor | 524 N Tillamook St Ste 102b, Portland, OR 97227-1993 | 2020-09-22 |
| 1326654765 | Naomi Painter | Counselor | 1925 Ne 19th Ave Apt 8a, Portland, OR 97212-4526 | 2020-09-21 |
| 1750996104 | Sara Fuller | Counselor | 3016 Ne 70th Ave, Portland, OR 97213-5802 | 2020-09-12 |
| 1114532983 | Matthew W Cronin | Counselor | 1122 Ne 122nd Ave Ste 200, Portland, OR 97230-2081 | 2020-09-09 |
| 1447865381 | Luke Colbourn | Counselor | 2705 E Burnside St Ste 206, Portland, OR 97214-1768 | 2020-09-08 |
| 1710599774 | Abigail Kathryn Ernst | Counselor | 1020 Sw Taylor St # 100, Portland, OR 97205-2543 | 2020-08-20 |
| Find all providers in PORTLAND | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.