Provider Demographics
NPI:1811405707
Name:BEDARD, MADX OMNI (MSW, QMHP-R)
Entity type:Individual
Prefix:
First Name:MADX
Middle Name:OMNI
Last Name:BEDARD
Suffix:
Gender:M
Credentials:MSW, QMHP-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 SE KING RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97222-2891
Mailing Address - Country:US
Mailing Address - Phone:503-358-7884
Mailing Address - Fax:
Practice Address - Street 1:6902 SE LAKE RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97267-2148
Practice Address - Country:US
Practice Address - Phone:503-358-7884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-13
Last Update Date:2025-10-03
Deactivation Date:2022-01-24
Deactivation Code:
Reactivation Date:2025-08-11
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health