Provider Demographics
NPI:1235400375
Name:MENKE-THIELMAN, FOREST
Entity Type:Individual
Prefix:
First Name:FOREST
Middle Name:
Last Name:MENKE-THIELMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14513 SE STARK ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97233-2155
Mailing Address - Country:US
Mailing Address - Phone:503-328-0240
Mailing Address - Fax:503-328-0241
Practice Address - Street 1:14513 SE STARK ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233-2155
Practice Address - Country:US
Practice Address - Phone:503-328-0240
Practice Address - Fax:503-328-0241
Is Sole Proprietor?:No
Enumeration Date:2012-01-20
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker