Provider Demographics
NPI:1528705035
Name:MARLETTE, JENELLE (MA, LPCC LADC CADC-1)
Entity type:Individual
Prefix:
First Name:JENELLE
Middle Name:
Last Name:MARLETTE
Suffix:
Gender:F
Credentials:MA, LPCC LADC CADC-1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5398 SW TOUCHSTONE PL
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333-2943
Mailing Address - Country:US
Mailing Address - Phone:218-585-9400
Mailing Address - Fax:
Practice Address - Street 1:5398 SW TOUCHSTONE PL
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333-2943
Practice Address - Country:US
Practice Address - Phone:218-368-6453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-16
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR21R40101YA0400X
MN305392101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)