Provider Demographics
NPI:1528705035
Name:MARLETTE, JENELLE M (MA, LPC, CADC1)
Entity type:Individual
Prefix:
First Name:JENELLE
Middle Name:M
Last Name:MARLETTE
Suffix:
Gender:F
Credentials:MA, LPC, CADC1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 NE 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-3148
Mailing Address - Country:US
Mailing Address - Phone:218-585-9400
Mailing Address - Fax:
Practice Address - Street 1:224 NE 28TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-3148
Practice Address - Country:US
Practice Address - Phone:218-585-9400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-16
Last Update Date:2025-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR21R40101YA0400X
MN305392101YA0400X
MNCC3101101YP2500X
ORC7146101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional