KIMBERLY CANTONWINE M.A.
NPI 1104232032
Counselor - Mental Health in Portland, OR

Q: What is Kimberly Cantonwine's NPI number?

The NPI number for Kimberly Cantonwine is 1104232032. It was assigned to this individual provider in the NPPES registry on July 11, 2014.

Q: What is Kimberly Cantonwine's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

Active since July 11, 2014PECOS EnrolledAccepts Medicare Assignment

2415 SE 43RD AVE STE 200, PORTLAND, OR 97206(503) 238-0705 Get Directions Write a Review

NPPES record last updated: March 12, 2020. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Mar 12, 2020, May 16, 2019 (2 updates tracked since 2019).

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About Kimberly Cantonwine M.a. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KIMBERLY CANTONWINE M.A. (NPI 1104232032) is an individual mental health provider in Portland, Oregon and active in the NPI registry since July 2014. She is enrolled in Medicare PECOS and is a graduate of Other (2013).

NPPES Registry Identity

NPI1104232032

Entity TypeIndividualFemale

Primary Taxonomy101YM0800X

Provider Legal NameKIMBERLY CANTONWINECredential: M.A.

Location Address2415 SE 43RD AVE STE 200Portland, OR 97206-1671

Mailing AddressPo Box 8459Portland, OR 97207-8459

Phone(503) 238-0705

Sole ProprietorNo

Medical School CMSOtherGraduated 2013

Enumeration DateJuly 11, 2014

Last NPPES UpdateMarch 12, 20202 updates tracked since enumeration

NPPES CertifiedMarch 12, 2020

✔ NPI 1104232032 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers

Taxonomy Code101YM0800X

Also ListedCounselor · Addiction (Substance Use Disorder)Taxonomy 101YA0400X · License R3328 (OR)

2415 SE 43RD AVE STE 200, Portland, OR 97206

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include BridgeSpan Health Company, Kaiser Permanente, Moda Health Plan, Inc. and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Kimberly Cantonwine M.a. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID8123530383

PECOS Enrollment IDI20250624001108

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 9

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

LISHA SONG

Counselor (Mental Health)