Healthcare Provider Details

I. General information

NPI: 1740004738
Provider Name (Legal Business Name): MADDISON MARTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2024
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 N COURT ST
VISALIA CA
93291-4913
US

IV. Provider business mailing address

512 N COURT ST
VISALIA CA
93291-4913
US

V. Phone/Fax

Practice location:
  • Phone: 559-754-3011
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: