Healthcare Provider Details

I. General information

NPI: 1366360018
Provider Name (Legal Business Name): MS. MADISON RODRIGUEZ EBERTH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3358 CHELSEA CIR
ANN ARBOR MI
48108-2717
US

IV. Provider business mailing address

3358 CHELSEA CIR
ANN ARBOR MI
48108-2717
US

V. Phone/Fax

Practice location:
  • Phone: 313-575-8156
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851119413
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: