Healthcare Provider Details

I. General information

NPI: 1174242101
Provider Name (Legal Business Name): MADELINE DAILEY MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MIK DAILEY MA

II. Dates (important events)

Enumeration Date: 08/23/2022
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4127 SE CLINTON ST
PORTLAND OR
97202-1638
US

IV. Provider business mailing address

4127 SE CLINTON ST
PORTLAND OR
97202-1638
US

V. Phone/Fax

Practice location:
  • Phone: 503-208-6624
  • Fax: 971-245-7999
Mailing address:
  • Phone: 801-404-8307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberT3061
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: