Healthcare Provider Details

I. General information

NPI: 1528977659
Provider Name (Legal Business Name): MADISON GEREN BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 S HALLIBURTON ST
KIRKSVILLE MO
63501-3712
US

IV. Provider business mailing address

2203 S MARION ST APT B
KIRKSVILLE MO
63501-4747
US

V. Phone/Fax

Practice location:
  • Phone: 660-786-7551
  • Fax:
Mailing address:
  • Phone: 816-214-1411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number2026043044
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: