Individual
KATE MADDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1748 NW FAIRVIEW DR # A, GRESHAM, OR 97030-3842
(503) 492-3910
(503) 674-6706
Mailing address
1748 NW FAIRVIEW DR # A, GRESHAM, OR 97030-3842
(503) 724-0378
Taxonomy
Speciality
Code
Description
License number
State
246Z00000X
Other Specialist/Technologist
Primary
21477
OR
405300000X
Prevention Professional
21477
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21477
LMT
OR
Enumeration date
09/24/2020
Last updated
09/24/2020
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