Provider Demographics
NPI:1417142654
Name:ALDERSON, MICHELE ARLENE (LICENSED CLINICAL SO)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:ARLENE
Last Name:ALDERSON
Suffix:
Gender:F
Credentials:LICENSED CLINICAL SO
Other - Prefix:MS
Other - First Name:MICHELE
Other - Middle Name:ARLENE
Other - Last Name:HOEFT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICENSED CLINICAL SO
Mailing Address - Street 1:PO BOX 2166
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97308-2166
Mailing Address - Country:US
Mailing Address - Phone:503-581-0808
Mailing Address - Fax:503-371-0991
Practice Address - Street 1:280 COURT ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301
Practice Address - Country:US
Practice Address - Phone:503-581-0808
Practice Address - Fax:503-371-0991
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR19571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR101448Medicare PIN