Provider Demographics
NPI:1336286582
Name:HOCKETT, MELISSA L (MSW, CADC II)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:L
Last Name:HOCKETT
Suffix:
Gender:F
Credentials:MSW, CADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3325 N INTERSTATE AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-1020
Mailing Address - Country:US
Mailing Address - Phone:503-331-6484
Mailing Address - Fax:
Practice Address - Street 1:3325 N INTERSTATE AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1020
Practice Address - Country:US
Practice Address - Phone:503-331-6484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR04-03-21101YA0400X
ORCSWA-A40711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)