Provider Demographics
NPI:1982930244
Name:COLE, MELISSA ANN (IBCLC, RLC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:COLE
Suffix:
Gender:F
Credentials:IBCLC, RLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1906 NW 25TH AVE
Mailing Address - Street 2:STE 10
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-2567
Mailing Address - Country:US
Mailing Address - Phone:360-830-6455
Mailing Address - Fax:360-543-7085
Practice Address - Street 1:1906 NW 25TH AVE
Practice Address - Street 2:STE 10
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2567
Practice Address - Country:US
Practice Address - Phone:360-830-6455
Practice Address - Fax:360-543-7085
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-21
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
10975484174400000X, 174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No174400000XOther Service ProvidersSpecialist