Healthcare Provider Details

I. General information

NPI: 1295648756
Provider Name (Legal Business Name): MADISON MARIE JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 BRIGHAM ST
PLAINWELL MI
49080-1598
US

IV. Provider business mailing address

720 BRIGHAM ST
PLAINWELL MI
49080-1574
US

V. Phone/Fax

Practice location:
  • Phone: 269-685-5813
  • Fax:
Mailing address:
  • Phone: 269-685-5813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801121397
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: