Healthcare Provider Details

I. General information

NPI: 1841152550
Provider Name (Legal Business Name): MADELINE ROSALES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 SE 217TH AVE
GRESHAM OR
97030-2429
US

IV. Provider business mailing address

12800 NE 4TH ST
VANCOUVER WA
98684-5051
US

V. Phone/Fax

Practice location:
  • Phone: 503-661-6415
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: