Healthcare Provider Details

I. General information

NPI: 1932983897
Provider Name (Legal Business Name): MADELINE ELLISON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MADELINE JENKINS M.ED., BCBA

II. Dates (important events)

Enumeration Date: 08/22/2023
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 E 57TH ST
SIOUX FALLS SD
57108
US

IV. Provider business mailing address

5000 E 57TH ST
SIOUX FALLS SD
57108-8829
US

V. Phone/Fax

Practice location:
  • Phone: 605-215-1592
  • Fax:
Mailing address:
  • Phone: 605-215-1592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-288794
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: