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General NPI Number Information
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NPI Number | 1730853813
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Entity Type | Individual
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Provider Name | MADISON AVERY FREMIN MA, BCBA
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Gender | Female
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Dates
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Enumeration Date | 08/03/2021
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Last Update Date | 08/04/2025
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Provider Practice Location Address
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Address Line | 610 W PINHOOK RD
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City | LAFAYETTE
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State | LA
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Zip | 70503-2314
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Country | US
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Telephone | 318-597-5112
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Fax |
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Provider Business Mailing Address
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Address Line | 114 E CAPPEL ST
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City | MARKSVILLE
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State | LA
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Zip | 71351-2456
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Country | US
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Telephone | 318-597-5112
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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 | L-562
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License Number State | LA
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