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General NPI Number Information
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NPI Number | 1275182909
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Entity Type | Individual
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Provider Name | MADELINE AMMAR
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Gender | Female
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Dates
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Enumeration Date | 09/05/2019
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Last Update Date | 07/25/2025
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Provider Practice Location Address
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Address Line | 1915 NE STUCKI AVE STE 308
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City | BEAVERTON
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State | OR
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Zip | 97006-6951
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Country | US
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Telephone | 971-249-2149
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Fax | 503-809-8458
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Provider Business Mailing Address
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Address Line | 10350 N VANCOUVER WAY # 5338
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City | PORTLAND
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State | OR
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Zip | 97217-7530
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Country | US
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Telephone | 971-249-2149
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Fax | 503-809-8458
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | L11333
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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