Provider Demographics
NPI:1629125216
Name:MELUM, ARLA JEANNE (MASTERS DEGREE)
Entity Type:Individual
Prefix:
First Name:ARLA
Middle Name:JEANNE
Last Name:MELUM
Suffix:
Gender:F
Credentials:MASTERS DEGREE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 NE 74TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-6232
Mailing Address - Country:US
Mailing Address - Phone:503-916-5570
Mailing Address - Fax:503-916-2750
Practice Address - Street 1:833 NE 74TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-6232
Practice Address - Country:US
Practice Address - Phone:503-916-5570
Practice Address - Fax:503-916-2750
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20573231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR216507Medicaid