Provider Demographics
NPI:1164003349
Name:GOLDADER, MELISSA J
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:J
Last Name:GOLDADER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:J
Other - Last Name:MONTELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 962
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:OR
Mailing Address - Zip Code:97140-0962
Mailing Address - Country:US
Mailing Address - Phone:971-832-1145
Mailing Address - Fax:
Practice Address - Street 1:21887 SW SHERWOOD BLVD STE B
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:OR
Practice Address - Zip Code:97140-9412
Practice Address - Country:US
Practice Address - Phone:971-266-3833
Practice Address - Fax:971-979-1090
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-19
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR7741101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health