MEDICARE: MRS. MARY MEIKLE MSW,LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	3351	OR

General Provider Information

NPI Number	:	1083694244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY MEIKLE MSW,LCSW

Provider Business Mailing Address
First Line	:	17483 SE RESERVE LOOP
Second Line	:
City	:	MILWAUKIE
State	:	OR
Zip	:	97267-5963
Country	:	US
Telephone Number	:	503-423-7009
Fax Number	:

Provider Business Practice Location Address
First Line	:	4310 SE WOODSTOCK BLVD
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97206-6270
Country	:	US
Telephone Number	:	503-423-7009
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/21/2006
Last Update Date	:	05/05/2026

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