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General NPI Number Information
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NPI Number | 1043718174
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Entity Type | Individual
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Provider Name | MADISON GANDEN MA, BCBA, LBA
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Gender | Female
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Dates
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Enumeration Date | 01/23/2018
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Last Update Date | 11/30/2018
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Provider Practice Location Address
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Address Line | 9374 OLIVE BLVD
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City | OLIVETTE
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State | MO
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Zip | 63132-3253
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Country | US
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Telephone | 314-932-2402
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Fax |
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Provider Business Mailing Address
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Address Line | 1090 PROGRESS PKWY APT 12A
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City | STE GENEVIEVE
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State | MO
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Zip | 63670-8978
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Country | US
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Telephone | 636-697-4229
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 2017031338
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License Number State | MO
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