Healthcare Provider Details

I. General information

NPI: 1518861780
Provider Name (Legal Business Name): MADELYNN DUNHAM
Entity Type: Individual
Gender:
Sole Proprietor: N

Provider Other Name: MADDIE DUNHAM

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 SW STATE ST STE A
ANKENY IA
50023-2555
US

IV. Provider business mailing address

845 SHAWNEE AVE
DES MOINES IA
50313-3359
US

V. Phone/Fax

Practice location:
  • Phone: 515-620-2558
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: