Healthcare Provider Details

I. General information

NPI: 1578036158
Provider Name (Legal Business Name): MADISON E HEUERTZ MCFALL LPC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2019
Last Update Date: 02/22/2024
Certification Date: 02/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 JUANIPERO WAY
MEDFORD OR
97504
US

IV. Provider business mailing address

5584 TRIBUTE WAY
EUGENE OR
97402-7586
US

V. Phone/Fax

Practice location:
  • Phone: 541-816-4131
  • Fax: 458-226-2163
Mailing address:
  • Phone: 541-944-3943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberR8349
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: