Healthcare Provider Details

I. General information

NPI: 1710330816
Provider Name (Legal Business Name): MEGAN PADILLA PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2016
Last Update Date: 12/17/2019
Certification Date: 12/17/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 E POWELL BLVD
GRESHAM OR
97080-1365
US

IV. Provider business mailing address

4799 SW GREENSBORO WAY APT 58
BEAVERTON OR
97078-2789
US

V. Phone/Fax

Practice location:
  • Phone: 503-669-4300
  • Fax:
Mailing address:
  • Phone: 602-570-0252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3162
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: