Healthcare Provider Details

I. General information

NPI: 1760947444
Provider Name (Legal Business Name): MADISON BLOOMSTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2019
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 PROSPECT AVE
HOOD RIVER OR
97031-2161
US

IV. Provider business mailing address

415 PROSPECT AVE
HOOD RIVER OR
97031-2161
US

V. Phone/Fax

Practice location:
  • Phone: 541-399-6232
  • Fax:
Mailing address:
  • Phone: 541-399-6232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberR12366
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: