Provider Demographics
NPI:1083694244
Name:MEIKLE, MARY (MSW,LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:
Last Name:MEIKLE
Suffix:
Gender:F
Credentials:MSW,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12854 SE 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-7902
Mailing Address - Country:US
Mailing Address - Phone:503-652-9292
Mailing Address - Fax:
Practice Address - Street 1:2607 SE HAWTHORNE BLVD
Practice Address - Street 2:SUITE H
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-2941
Practice Address - Country:US
Practice Address - Phone:503-239-6337
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR33511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical