Healthcare Provider Details

I. General information

NPI: 1053936161
Provider Name (Legal Business Name): KENDRA-MARIE MADDISON GARCIA MD, BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2020
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 PLYMOUTH AVE NE
GRAND RAPIDS MI
49505-6028
US

IV. Provider business mailing address

424 PLYMOUTH AVE NE
GRAND RAPIDS MI
49505-6028
US

V. Phone/Fax

Practice location:
  • Phone: 833-328-8476
  • Fax:
Mailing address:
  • Phone: 833-328-8476
  • Fax:

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 Number7401003310
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: