Provider Demographics
NPI:1902142516
Name:MADDUX, KRISTENE ELIZABETH
Entity type:Individual
Prefix:MS
First Name:KRISTENE
Middle Name:ELIZABETH
Last Name:MADDUX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRISTENE
Other - Middle Name:ELIZABETH
Other - Last Name:TODD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:550 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-3212
Mailing Address - Country:US
Mailing Address - Phone:541-505-5485
Mailing Address - Fax:
Practice Address - Street 1:550 RIVER RD
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97404-3212
Practice Address - Country:US
Practice Address - Phone:541-505-5485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-31
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health