Healthcare Provider Details

I. General information

NPI: 1477444230
Provider Name (Legal Business Name): MADISON GIBBONS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2025
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 LYN RD
BOWLING GREEN OH
43402-3525
US

IV. Provider business mailing address

1210 LYN RD
BOWLING GREEN OH
43402-3525
US

V. Phone/Fax

Practice location:
  • Phone: 419-461-0681
  • Fax:
Mailing address:
  • Phone: 419-461-3430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: