Healthcare Provider Details

I. General information

NPI: 1407695521
Provider Name (Legal Business Name): MADISON CHLOE SIDERS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2024
Last Update Date: 05/20/2024
Certification Date: 05/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 OHIO PIKE STE 312
CINCINNATI OH
45255-3629
US

IV. Provider business mailing address

2700 BETHLEHEM RD
WINCHESTER OH
45697-9403
US

V. Phone/Fax

Practice location:
  • Phone: 513-770-1705
  • Fax: 513-528-0106
Mailing address:
  • Phone: 937-752-8071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.2405943
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: