Healthcare Provider Details

I. General information

NPI: 1801700737
Provider Name (Legal Business Name): MADISON VANDEN BOOM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3510 N OAKLAND AVE STE 203
SHOREWOOD WI
53211-2746
US

IV. Provider business mailing address

3510 N OAKLAND AVE STE 203
SHOREWOOD WI
53211-2746
US

V. Phone/Fax

Practice location:
  • Phone: 414-939-8748
  • Fax: 414-377-4203
Mailing address:
  • Phone: 414-939-8748
  • Fax: 414-377-4203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: