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General NPI Number Information
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NPI Number | 1528705035
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Entity Type | Individual
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Provider Name | JENELLE M. MARLETTE MA, LPC, CADC1
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Gender | Female
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Dates
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Enumeration Date | 05/16/2022
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Last Update Date | 08/03/2025
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Provider Practice Location Address
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Address Line | 224 NE 28TH AVE
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City | PORTLAND
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State | OR
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Zip | 97232-3148
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Country | US
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Telephone | 218-585-9400
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Fax |
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Provider Business Mailing Address
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Address Line | 224 NE 28TH AVE
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City | PORTLAND
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State | OR
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Zip | 97232-3148
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Country | US
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Telephone | 218-585-9400
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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 | 21R40
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 305392
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | CC3101
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License Number State | MN
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Taxonomy #4
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | C7146
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License Number State | OR
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