KIMBERLY JAYE RANDALL CADC, CRM
NPI 1669991212
Peer Specialist in Portland, OR

Q: What is the provider's specialty?

The provider's specialty is Peer Specialist with taxonomy code 175T00000X.

Active since September 14, 2017

1030 NE COUCH ST, PORTLAND, OR 97232(503) 239-8400(503) 239-8406 Get Directions Write a Review

NPPES record last updated: August 31, 2023. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Aug 31, 2023, Sep 14, 2017 (2 updates tracked since 2017).

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About Kimberly Jaye Randall Cadc, Crm NPPES

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

KIMBERLY JAYE RANDALL CADC, CRM (NPI 1669991212) is an individual peer specialist in Portland, Oregon, licensed in Oregon (THW1868) and active in the NPI registry since September 2017. She maintains a secondary practice location in Portland.

NPPES Registry Identity

NPI1669991212

Entity TypeIndividualFemale

Primary Taxonomy175T00000X

Provider Legal NameKIMBERLY JAYE RANDALLCredential: CADC, CRM

Location Address1030 NE COUCH STPortland, OR 97232

Mailing Address14600 Nw Cornell RdPortland, OR 97229-5442 · (503) 645-3581 · Fax (503) 629-8517

Phone(503) 239-8400

Fax(503) 239-8406

Sole ProprietorYes

Enumeration DateSeptember 14, 2017

Last NPPES UpdateAugust 31, 20232 updates tracked since enumeration

NPPES CertifiedAugust 31, 2023

✔ NPI 1669991212 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPeer SpecialistOther Service Providers

Taxonomy Code175T00000X

License✔ Licensed in OR · THW1868

Definition

Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority.

1030 NE COUCH ST, Portland, OR 97232

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