Provider Demographics
NPI:1174242101
Name:DAILEY, MADELINE (MA)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:
Last Name:DAILEY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:MIK
Other - Middle Name:
Other - Last Name:DAILEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:4127 SE CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-1638
Mailing Address - Country:US
Mailing Address - Phone:801-404-8307
Mailing Address - Fax:
Practice Address - Street 1:4127 SE CLINTON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-1638
Practice Address - Country:US
Practice Address - Phone:503-208-6624
Practice Address - Fax:971-245-7999
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-23
Last Update Date:2025-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT3061106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist