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NPI Code Detail

MEDICARE: MADYSON TELLKAMP

MEDICARE: MADYSON TELLKAMP
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
1390200000XStudent in an Organized Health Care Education/Training Program
2106H00000XMarriage & Family Therapist161229CA

General Provider Information

NPI Number : 1396576799
Entity Type Code : Individual
Provider Name (Legal Business Name) : MADYSON TELLKAMP
Provider Business Mailing Address
First Line : 840 N AVENUE 66
Second Line :
City : LOS ANGELES
State : CA
Zip : 90042-1508
Country : US
Telephone Number : 626-395-7100
Fax Number :
Provider Business Practice Location Address
First Line : 840 N AVENUE 66
Second Line :
City : LOS ANGELES
State : CA
Zip : 90042-1508
Country : US
Telephone Number : 626-395-7100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/08/2024
Last Update Date : 02/13/2026

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Directions to “ MADYSON TELLKAMP ” Practice Location

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