Healthcare Provider Details

I. General information

NPI: 1386581635
Provider Name (Legal Business Name): MADISON KAY HAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15116 N COTTON LN
SURPRISE AZ
85388-9618
US

IV. Provider business mailing address

15116 N COTTON LN
SURPRISE AZ
85388-9618
US

V. Phone/Fax

Practice location:
  • Phone: 623-322-8250
  • Fax:
Mailing address:
  • Phone: 623-322-8250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: