Provider Demographics
NPI:1619227329
Name:JANSSEN, MELISSA CARTER (LCSW)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:CARTER
Last Name:JANSSEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8840 SW WILLOW LN
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-2810
Mailing Address - Country:US
Mailing Address - Phone:503-475-6370
Mailing Address - Fax:971-244-7288
Practice Address - Street 1:8835 SW CANYON LN STE 234
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-3438
Practice Address - Country:US
Practice Address - Phone:503-475-6370
Practice Address - Fax:971-244-7288
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-11
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW602841461041C0700X
ORL34981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical