Healthcare Provider Details

I. General information

NPI: 1477468775
Provider Name (Legal Business Name): MADISON JODECI AHLGREN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W SPRING ST
MARQUETTE MI
49855-4661
US

IV. Provider business mailing address

200 W SPRING ST
MARQUETTE MI
49855-4661
US

V. Phone/Fax

Practice location:
  • Phone: 906-225-1181
  • Fax: 906-225-7203
Mailing address:
  • Phone: 906-225-1181
  • Fax: 906-225-7203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number1074773
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: