Individual
DR. MELISSA FREDETTE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
1235 SE DIVISION ST STE 109, PORTLAND, OR 97202-1042
(503) 343-9939
(503) 689-8686
Mailing address
2135 SE ELLIOTT AVE, PORTLAND, OR 97214-5341
(503) 396-2638
(503) 689-8686
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
9838
MA
103TC0700X
Clinical Psychologist
Primary
2156
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
164936
—
OR
01
—
R0000WDBCH
MEDICARE GROUP
OR
Enumeration date
01/21/2011
Last updated
01/16/2025
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