Healthcare Provider Details

I. General information

NPI: 1598604647
Provider Name (Legal Business Name): MADISON PINKERTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 GARDEN OF THE GODS RD
COLORADO SPRINGS CO
80907-3489
US

IV. Provider business mailing address

520 WOLF RANCH PKWY APT 3224
GEORGETOWN TX
78628-4199
US

V. Phone/Fax

Practice location:
  • Phone: 719-354-5297
  • Fax:
Mailing address:
  • Phone: 719-354-5297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberBACB921580
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: