Provider Demographics
NPI:1750687182
Name:KIEFFER, MELISSA J
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:J
Last Name:KIEFFER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3808 N WILLIAMS AVE STE F
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-1468
Mailing Address - Country:US
Mailing Address - Phone:503-902-4797
Mailing Address - Fax:
Practice Address - Street 1:3808 N WILLIAMS AVE STE F
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1468
Practice Address - Country:US
Practice Address - Phone:503-902-4797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-02
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
OR19839225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor