Provider Demographics
NPI:1518619725
Name:BUDLONG, MELANIE FRANCES (LAC)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:FRANCES
Last Name:BUDLONG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:FRANCES
Other - Last Name:HODGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8338 N INTERSTATE AVE APT 301
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-6749
Mailing Address - Country:US
Mailing Address - Phone:503-490-7064
Mailing Address - Fax:
Practice Address - Street 1:2614 E ST
Practice Address - Street 2:
Practice Address - City:WASHOUGAL
Practice Address - State:WA
Practice Address - Zip Code:98671-1714
Practice Address - Country:US
Practice Address - Phone:503-490-7064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC61258060171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist