Individual provider Active NPI

Melanie Swallow

  • Clinical Social Worker
  • Damascus, OR
National Provider Identifier
1265717292
Registry record updated Jun 17, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
L6502 Issued in OR
Practice address
14450 SE Royer Rd
Damascus, OR 97089-8730
Phone
(503) 658-5521
Fax
(503) 658-5002
NPI assigned
Oct 21, 2011
Last updated
Jun 17, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X L6502 NU
Clinical Social Worker 1041C0700X L6502 OR Primary

Addresses

Primary practice location

14450 SE Royer Rd
Damascus, OR 97089-8730

Mailing address

3587 Heathrow Way
Medford, OR 97504-4004
Phone (541) 858-8170

Other practice location 1

1945 NE 205th Ave
Fairview, OR 97024-9622
Phone (541) 858-8170

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180604002760 OR Practitioner - Clinical Social Worker 3173888658 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tiffany Kettermann LLCGroup PAC ID 0941685184, 5 clinicians

Practice addresses (Care Compare)

2950 SE Stark St
Suite 130
Portland, OR 97214-3082
Phone (971) 270-0167

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Tiffany Kettermann, LLC Mental Health CurrentSince Dec 29, 2023 Accepting new patients

Locations

2950 SE Stark St
Ste 130
Portland, OR 97214
Phone (971) 270-0167

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1319155200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1781654400000",
    "number": "1265717292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3587 HEATHROW WAY",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975044004",
            "telephone_number": "541-858-8170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14450 SE ROYER RD",
            "city": "DAMASCUS",
            "state": "OR",
            "postal_code": "970898730",
            "telephone_number": "503-658-5521",
            "fax_number": "503-658-5002"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1945 NE 205th Ave",
            "address_purpose": "LOCATION",
            "city": "Fairview",
            "state": "OR",
            "postal_code": "970249622",
            "country_code": "US",
            "telephone_number": "541-858-8170",
            "fax_number": "541-858-8167",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SWALLOW",
        "first_name": "MELANIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-10-21",
        "last_updated": "2026-06-17",
        "certification_date": "2026-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": "L6502",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "L6502",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Damascus, OR

Sources for this page

Verify at the official NPI Registry.