MEDICARE: DR. MELISSA FREDETTE PH.D.

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	103T00000X	Psychologist	9838	MA
2	103TC0700X	Clinical Psychologist	2156	OR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	R0000WDBCH	OTHER	OR	MEDICARE GROUP

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124323118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MELISSA FREDETTE PH.D.

Provider Business Mailing Address
First Line	:	2135 SE ELLIOTT AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97214-5341
Country	:	US
Telephone Number	:	503-396-2638
Fax Number	:	503-689-8686

Provider Business Practice Location Address
First Line	:	1235 SE DIVISION ST STE 109
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97202-1042
Country	:	US
Telephone Number	:	503-343-9939
Fax Number	:	503-689-8686

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

Provider Enumeration Date	:	01/21/2011
Last Update Date	:	01/16/2025

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Directions to “ DR. MELISSA FREDETTE PH.D.” Practice Location

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