=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023339488
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MELANIE ROEDEL LPC, MA MFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/18/2010
-----------------------------------------------------
Last Update Date | 09/04/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5289 NE ELAM YOUNG PKWY STE 140
-----------------------------------------------------
City | HILLSBORO
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97124
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-372-5147
-----------------------------------------------------
Fax | 503-640-4001
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1176 NW FALL AVE
-----------------------------------------------------
City | BEAVERTON
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97006-4033
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-544-1734
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | REGISTERED INTERN
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | C3482
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------