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NPI Code Detail

MEDICARE: MADELINE LOUISE STAFFORD

MEDICARE: MADELINE LOUISE STAFFORD
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 TechnicianABA-IN-10254104OR

General Provider Information

NPI Number : 1619288669
Entity Type Code : Individual
Provider Name (Legal Business Name) : MADELINE LOUISE STAFFORD
Provider Business Mailing Address
First Line : 18765 SW BOONES FERRY RD STE 100
Second Line :
City : TUALATIN
State : OR
Zip : 97062-8607
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 18765 SW BOONES FERRY RD STE 100
Second Line :
City : TUALATIN
State : OR
Zip : 97062-8607
Country : US
Telephone Number : 503-612-1000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/24/2010
Last Update Date : 04/02/2025

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Directions to “ MADELINE LOUISE STAFFORD ” Practice Location

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