Provider Demographics
NPI:1316749013
Name:OEDELL, MACKENZIE (CADC-R)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:
Last Name:OEDELL
Suffix:
Gender:F
Credentials:CADC-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 SHIRLEY ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:MOLALLA
Mailing Address - State:OR
Mailing Address - Zip Code:97038-8889
Mailing Address - Country:US
Mailing Address - Phone:971-235-0776
Mailing Address - Fax:971-235-0776
Practice Address - Street 1:411 NE 19TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-4801
Practice Address - Country:US
Practice Address - Phone:971-405-5307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)