Provider Demographics
NPI:1114350436
Name:HOECKLE, MELINDY ANN (BS, QMHA)
Entity Type:Individual
Prefix:
First Name:MELINDY
Middle Name:ANN
Last Name:HOECKLE
Suffix:
Gender:F
Credentials:BS, QMHA
Other - Prefix:
Other - First Name:MINDY
Other - Middle Name:ANN
Other - Last Name:HOECKLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:425 2ND AVE SW STE 101
Mailing Address - Street 2:P.O. BOX 100
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-2483
Mailing Address - Country:US
Mailing Address - Phone:541-967-3866
Mailing Address - Fax:541-812-8807
Practice Address - Street 1:425 2ND AVE SW
Practice Address - Street 2:SUITE 101
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-2482
Practice Address - Country:US
Practice Address - Phone:541-967-3866
Practice Address - Fax:541-812-8807
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-11
Last Update Date:2013-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator