Healthcare Provider Details

I. General information

NPI: 1689388159
Provider Name (Legal Business Name): MADALENE GILLIAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MADALENE BAILEY

II. Dates (important events)

Enumeration Date: 01/10/2023
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 W 26TH ST
JOPLIN MO
64804-1904
US

IV. Provider business mailing address

705 W 26TH ST
JOPLIN MO
64804-1904
US

V. Phone/Fax

Practice location:
  • Phone: 417-627-9994
  • Fax: 417-627-9995
Mailing address:
  • Phone: 417-627-9994
  • Fax: 417-627-9995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: