Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Mr. Shane D Kennington, LCSW

Individual provider Clinical Social Worker · NPI 1174754493

Mr. Shane D Kennington, LCSW is a Clinical Social Worker in Portland, Oregon. Qualified in 2005, 21 years ago. Practices as a sole proprietor, accepts Medicare assignment and offers telehealth. Licensed in Oregon.

Years since qualifying
21
Licensed in
OR
In the registry since
2009
What do these letters mean?
LCSW — Licensed Clinical Social Worker
A social worker licensed to diagnose and treat mental health conditions independently.

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Practice location Address checks out

1750 SW Skyline Blvd Ste 206
Portland, OR 97221-2545
Phone: (503) 327-5584
Fax: (971) 351-6851
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence L7078 (OR)

Record details

NPI number1174754493
Entity typeIndividual (Type 1)
GenderMale
Credentials LCSW
Sole proprietorYes
NPI enumeratedAugust 4, 2009
Last updated in NPPESOctober 13, 2023
Certification dateOctober 13, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 2005 (21 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

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