MEDICARE: MADISYN ALIAH BABCOCK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1396333449
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADISYN ALIAH BABCOCK

Provider Business Mailing Address
First Line	:	8201 CASS AVE
Second Line	:
City	:	DARIEN
State	:	IL
Zip	:	60561-5314
Country	:	US
Telephone Number	:	630-590-5571
Fax Number	:

Provider Business Practice Location Address
First Line	:	8415 EXPLORER DR STE 130
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-1034
Country	:	US
Telephone Number	:	719-900-5690
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2021
Last Update Date	:	10/16/2024

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Directions to “ MADISYN ALIAH BABCOCK ” Practice Location

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