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NPI Code Detail

MEDICARE: MADISON TAYLOR WYATT

MEDICARE: MADISON TAYLOR WYATT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician
2103K00000XBehavior AnalystB-10244325OR

General Provider Information

NPI Number : 1609468461
Entity Type Code : Individual
Provider Name (Legal Business Name) : MADISON TAYLOR WYATT
Provider Business Mailing Address
First Line : 15750 SW OREGON ST APT 203
Second Line :
City : SHERWOOD
State : OR
Zip : 97140-9622
Country : US
Telephone Number : 949-310-5060
Fax Number :
Provider Business Practice Location Address
First Line : 7475 SW OLESON RD
Second Line :
City : PORTLAND
State : OR
Zip : 97223-7474
Country : US
Telephone Number : 971-804-0907
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/03/2021
Last Update Date : 06/11/2024

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Directions to “ MADISON TAYLOR WYATT ” Practice Location

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