Healthcare Provider Details

I. General information

NPI: 1770120628
Provider Name (Legal Business Name): MADISON ELAINE MICHEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2019
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 MCHENRY VILLAGE WAY STE 11B
MODESTO CA
95350-4341
US

IV. Provider business mailing address

1700 MCHENRY VILLAGE WAY STE 11B
MODESTO CA
95350-4341
US

V. Phone/Fax

Practice location:
  • Phone: 209-550-5869
  • Fax: 209-544-0487
Mailing address:
  • Phone: 209-550-5869
  • Fax: 209-544-0487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: