Provider Demographics
NPI:1689311565
Name:MUSTONEN, VALERIE MELISSA
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:MELISSA
Last Name:MUSTONEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:785 NW 90TH PL
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-6556
Mailing Address - Country:US
Mailing Address - Phone:503-816-5288
Mailing Address - Fax:
Practice Address - Street 1:785 NW 90TH PL
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-6556
Practice Address - Country:US
Practice Address - Phone:503-816-5288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-12
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL27711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical