Healthcare Provider Details

I. General information

NPI: 1104233667
Provider Name (Legal Business Name): EMILY FAIRCHILD-MADAR LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2014
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3880 SE 8TH AVE STE 150
PORTLAND OR
97202-3774
US

IV. Provider business mailing address

3880 SE 8TH AVE STE 150
PORTLAND OR
97202-3774
US

V. Phone/Fax

Practice location:
  • Phone: 503-446-3945
  • Fax:
Mailing address:
  • Phone: 503-446-3945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC3327
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: