Provider Demographics
NPI:1710330816
Name:PADILLA, MEGAN (PSYD)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:PADILLA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4799 SW GREENSBORO WAY APT 58
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97078-2789
Mailing Address - Country:US
Mailing Address - Phone:602-570-0252
Mailing Address - Fax:
Practice Address - Street 1:2222 E POWELL BLVD
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97080-1365
Practice Address - Country:US
Practice Address - Phone:503-669-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-13
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3162103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical