1023384922 NPI number — MELISSA KAY MULDER-WRIGHT MSW-LCSW

Table of content: MELISSA KAY MULDER-WRIGHT MSW-LCSW (NPI 1023384922)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023384922 NPI number — MELISSA KAY MULDER-WRIGHT MSW-LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MULDER-WRIGHT
Provider First Name:
MELISSA
Provider Middle Name:
KAY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW-LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MULDER
Provider Other First Name:
MELISSA
Provider Other Middle Name:
KAY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW-LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1023384922
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/02/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3808
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97208-3808
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-413-3958
Provider Business Mailing Address Fax Number:
503-413-3212

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2800 N VANCOUVER AVE
Provider Second Line Business Practice Location Address:
SUITE 230
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97227-1630
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-413-2901
Provider Business Practice Location Address Fax Number:
503-413-4898
Provider Enumeration Date:
03/26/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  L4761 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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