MEDICARE: MADELINE DAILEY MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	T3061	OR

General Provider Information

NPI Number	:	1174242101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADELINE DAILEY MA

Provider Business Mailing Address
First Line	:	4127 SE CLINTON ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97202-1638
Country	:	US
Telephone Number	:	801-404-8307
Fax Number	:

Provider Business Practice Location Address
First Line	:	4127 SE CLINTON ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97202-1638
Country	:	US
Telephone Number	:	503-208-6624
Fax Number	:	971-245-7999

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2022
Last Update Date	:	12/19/2025

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