Healthcare Provider Details

I. General information

NPI: 1225699424
Provider Name (Legal Business Name): MADISON ELIZABETH HARP MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2019
Last Update Date: 03/10/2022
Certification Date: 02/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2507 CHRISTIE DRIVE
LAKE OSWEGO OR
97034
US

IV. Provider business mailing address

PO BOX 368
MARYLHURST OR
97036-0368
US

V. Phone/Fax

Practice location:
  • Phone: 503-635-3416
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number842
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: