Healthcare Provider Details

I. General information

NPI: 1356350037
Provider Name (Legal Business Name): JEFFREY MADDEN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 05/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 OLENTANGY RIVER RD SUITE 2020
COLUMBUS OH
43214-3912
US

IV. Provider business mailing address

5450 FRANTZ RD SUITE 250
DUBLIN OH
43016-4141
US

V. Phone/Fax

Practice location:
  • Phone: 614-566-1190
  • Fax: 614-566-1191
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number4429
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number4429
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number4429
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: