Healthcare Provider Details

I. General information

NPI: 1689313819
Provider Name (Legal Business Name): MADISON BURDA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2022
Last Update Date: 06/04/2022
Certification Date: 06/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1710 W. SCHILLING ROAD
SALINA KS
67401-8131
US

IV. Provider business mailing address

1710 W. SCHILLING ROAD
SALINA KS
67401-8131
US

V. Phone/Fax

Practice location:
  • Phone: 785-823-9383
  • Fax: 785-823-2015
Mailing address:
  • Phone: 785-823-9383
  • Fax: 785-823-2015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: