Provider Demographics
NPI:1811418353
Name:SERVELLON-MARENCO, VANESSA ABIGAIL (MSW, QHMP)
Entity type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:ABIGAIL
Last Name:SERVELLON-MARENCO
Suffix:
Gender:F
Credentials:MSW, QHMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3407 S CORBETT AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-4621
Mailing Address - Country:US
Mailing Address - Phone:503-342-2649
Mailing Address - Fax:
Practice Address - Street 1:3407 S CORBETT AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-4621
Practice Address - Country:US
Practice Address - Phone:503-342-2649
Practice Address - Fax:844-206-0830
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-06
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
$$$$$$$$$OtherSOCIAL SECURITY