MEDICARE: MAKENNA ELIZABETH MADISON

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
1	106S00000X	Behavior Technician	CB70067718	WA

General Provider Information

NPI Number	:	1407715717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAKENNA ELIZABETH MADISON

Provider Business Mailing Address
First Line	:	10620 W 12TH AVE APT 63
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99224-7221
Country	:	US
Telephone Number	:	509-991-8067
Fax Number	:

Provider Business Practice Location Address
First Line	:	16201 E INDIANA AVE STE 3400
Second Line	:
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99216-2830
Country	:	US
Telephone Number	:	509-900-3669
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/21/2026
Last Update Date	:	01/21/2026

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