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General NPI Number Information
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NPI Number | 1255211819
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Entity Type | Individual
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Provider Name | MADISON RYLIE LARSON
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Gender | Female
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Dates
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Enumeration Date | 09/04/2025
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Last Update Date | 10/24/2025
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Provider Practice Location Address
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Address Line | 5889 WHITMORE LAKE RD STE 2
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City | BRIGHTON
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State | MI
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Zip | 48116-1998
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Country | US
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Telephone | 810-295-2699
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Fax |
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Provider Business Mailing Address
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Address Line | 8830 ISLAND LAKE RD
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City | DEXTER
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State | MI
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Zip | 48130-9516
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Country | US
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Telephone |
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 6851116542REL250003W
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License Number State | MI
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