Healthcare Provider Details

I. General information

NPI: 1902473739
Provider Name (Legal Business Name): MADYSON BROWN BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2021
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 DOCTORS PARK
SAINT CLOUD MN
56303-1207
US

IV. Provider business mailing address

109 DOCTORS PARK
SAINT CLOUD MN
56303-1207
US

V. Phone/Fax

Practice location:
  • Phone: 320-774-1908
  • Fax: 320-774-2034
Mailing address:
  • Phone: 320-774-1908
  • Fax: 320-774-2034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA0980
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: