Provider Demographics
NPI:1013203504
Name:MADEIRA, CORTNEY (MS ED/ CAS)
Entity Type:Individual
Prefix:
First Name:CORTNEY
Middle Name:
Last Name:MADEIRA
Suffix:
Gender:F
Credentials:MS ED/ CAS
Other - Prefix:
Other - First Name:CORTNEY
Other - Middle Name:
Other - Last Name:BRYANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSED/CAS
Mailing Address - Street 1:3415 SE POWELL BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202
Mailing Address - Country:US
Mailing Address - Phone:503-234-9591
Mailing Address - Fax:541-752-9270
Practice Address - Street 1:4455 NE HIGHWAY 20
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330
Practice Address - Country:US
Practice Address - Phone:541-758-5900
Practice Address - Fax:541-752-9270
Is Sole Proprietor?:No
Enumeration Date:2011-06-22
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health