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General NPI Number Information
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NPI Number | 1861109001
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Entity Type | Individual
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Provider Name | MADISON JACKSON M.S
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Gender | Female
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Dates
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Enumeration Date | 10/27/2022
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Last Update Date | 11/24/2025
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Provider Practice Location Address
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Address Line | 6060 PORTAL WAY
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City | FERNDALE
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State | WA
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Zip | 98248-7833
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Country | US
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Telephone | 360-676-6177
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Fax | 360-671-3574
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Provider Business Mailing Address
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Address Line | 2401 MITCHELL RD SE
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City | PORT ORCHARD
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State | WA
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Zip | 98366-4413
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Country | US
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Telephone | 360-865-2022
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MC70018676
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License Number State | WA
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