Healthcare Provider Details

I. General information

NPI: 1932065406
Provider Name (Legal Business Name): MADALYN ALLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2025
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3938 S LONE PINE AVE
SPRINGFIELD MO
65804-6859
US

IV. Provider business mailing address

3938 S LONE PINE AVE
SPRINGFIELD MO
65804-6859
US

V. Phone/Fax

Practice location:
  • Phone: 417-293-3464
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-445136
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: