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NPI Code Detail

MEDICARE: MADISON BROOK SMITH

MEDICARE: MADISON BROOK SMITH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1275370371
Entity Type Code : Individual
Provider Name (Legal Business Name) : MADISON BROOK SMITH
Provider Business Mailing Address
First Line : 1111 W GANSON ST
Second Line :
City : JACKSON
State : MI
Zip : 49202-4208
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1111 W GANSON ST
Second Line :
City : JACKSON
State : MI
Zip : 49202-4208
Country : US
Telephone Number : 810-498-0042
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/15/2024
Last Update Date : 07/15/2024

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Directions to “ MADISON BROOK SMITH ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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