Provider Demographics
NPI:1356354989
Name:BREITENSTEIN, MARGARET MARMADUKE (MA)
Entity type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:MARMADUKE
Last Name:BREITENSTEIN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:MAGGIE
Other - Middle Name:
Other - Last Name:MARMADUKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:14945 SW 98TH AVE
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-4705
Mailing Address - Country:US
Mailing Address - Phone:503-998-3027
Mailing Address - Fax:
Practice Address - Street 1:4855 SW WESTERN AVE
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-3460
Practice Address - Country:US
Practice Address - Phone:503-643-7565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC0991101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health