Provider Demographics
NPI:1811362122
Name:CAPENER, MELODIE
Entity Type:Individual
Prefix:
First Name:MELODIE
Middle Name:
Last Name:CAPENER
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 1:3587 HEATHROW WAY
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-4004
Mailing Address - Country:US
Mailing Address - Phone:503-421-7743
Mailing Address - Fax:
Practice Address - Street 1:14626 SE POWELL BLVD APT 106
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97236-2572
Practice Address - Country:US
Practice Address - Phone:971-254-9600
Practice Address - Fax:971-254-9598
Is Sole Proprietor?:No
Enumeration Date:2015-12-11
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health