Provider Demographics
NPI:1003448168
Name:DORRELL, MADELYN (LMT, CA)
Entity type:Individual
Prefix:
First Name:MADELYN
Middle Name:
Last Name:DORRELL
Suffix:
Gender:F
Credentials:LMT, CA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16679 BOONES FERRY RD STE 105
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-4378
Mailing Address - Country:US
Mailing Address - Phone:503-635-6005
Mailing Address - Fax:503-635-6016
Practice Address - Street 1:16679 BOONES FERRY RD STE 105
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-4378
Practice Address - Country:US
Practice Address - Phone:503-635-6005
Practice Address - Fax:503-635-6016
Is Sole Proprietor?:No
Enumeration Date:2020-02-06
Last Update Date:2025-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLMT-23591172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker