Healthcare Provider Details

I. General information

NPI: 1790345395
Provider Name (Legal Business Name): MADISON LYNN PRIDGEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2019
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12015 E 46TH AVE STE 300
DENVER CO
80239-3132
US

IV. Provider business mailing address

10041 DILLON CIR
COMMERCE CITY CO
80022-9592
US

V. Phone/Fax

Practice location:
  • Phone: 720-706-3396
  • Fax:
Mailing address:
  • Phone: 772-333-0991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: