Provider Demographics
NPI:1023339488
Name:ROEDEL, MELANIE (LPC, MA MFT)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:ROEDEL
Suffix:
Gender:F
Credentials:LPC, MA MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1176 NW FALL AVE
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-4033
Mailing Address - Country:US
Mailing Address - Phone:503-544-1734
Mailing Address - Fax:
Practice Address - Street 1:5289 NE ELAM YOUNG PKWY STE 140
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124
Practice Address - Country:US
Practice Address - Phone:503-372-5147
Practice Address - Fax:503-640-4001
Is Sole Proprietor?:No
Enumeration Date:2010-06-18
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORREGISTERED INTERN101YP2500X
106H00000X
ORC3482101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist