Healthcare Provider Details

I. General information

NPI: 1811449200
Provider Name (Legal Business Name): MISS AMY R MADRIGAL-BATES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2016
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 SW FRAZER AVE STE 282
PENDLETON OR
97801-0048
US

IV. Provider business mailing address

702 SUNSET DR
ONTARIO OR
97914
US

V. Phone/Fax

Practice location:
  • Phone: 541-278-6330
  • Fax: 541-278-5419
Mailing address:
  • Phone: 541-889-9167
  • Fax: 541-889-7873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberR7699
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: