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General NPI Number Information
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NPI Number | 1013718410
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Entity Type | Individual
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Provider Name | EDEN G. MELESE
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Gender | Female
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Dates
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Enumeration Date | 03/21/2025
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Last Update Date | 03/21/2025
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Provider Practice Location Address
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Address Line | 16707 SE HAIG ST
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City | PORTLAND
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State | OR
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Zip | 97236-1421
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Country | US
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Telephone | 503-278-6398
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Fax |
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Provider Business Mailing Address
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Address Line | 16707 SE HAIG ST
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City | PORTLAND
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State | OR
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Zip | 97236-1421
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Country | US
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Telephone | 503-278-6398
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | PENDING
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 171R00000X
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Taxonomy Name | Interpreter
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License Number | 112422
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number | 000000
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License Number State |
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Taxonomy #4
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number | PENDING
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License Number State | OR
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