Healthcare Provider Details

I. General information

NPI: 1184548190
Provider Name (Legal Business Name): MADISON ROTH ED.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5620 SW 61ST ST
TOPEKA KS
66619-2005
US

IV. Provider business mailing address

2652D SW ARROWHEAD RD
TOPEKA KS
66614-3872
US

V. Phone/Fax

Practice location:
  • Phone: 785-339-4946
  • Fax:
Mailing address:
  • Phone: 785-554-4333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number5352451496
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: