Provider Demographics
NPI:1962692228
Name:ENKOFF, MELANIE DAWN (LCSW)
Entity type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:DAWN
Last Name:ENKOFF
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:MELANIE
Other - Middle Name:DAWN
Other - Last Name:SAGE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:13635 SE SALMON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97233-1901
Mailing Address - Country:US
Mailing Address - Phone:503-257-0001
Mailing Address - Fax:
Practice Address - Street 1:13635 SE SALMON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233-1901
Practice Address - Country:US
Practice Address - Phone:503-257-0001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR39561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical