Healthcare Provider Details

I. General information

NPI: 1497672943
Provider Name (Legal Business Name): MADDISON MYERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2026
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2542 NE COURTNEY DR
BEND OR
97701-7685
US

IV. Provider business mailing address

21185 AZALIA AVE
BEND OR
97702-9482
US

V. Phone/Fax

Practice location:
  • Phone: 559-462-0161
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: