MEDICARE: MADISON 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
1	106S00000X	Behavior Technician		MI

General Provider Information

NPI Number	:	1477410736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADISON SMITH

Provider Business Mailing Address
First Line	:	309 N DESPELDER ST APT 6
Second Line	:
City	:	GRAND HAVEN
State	:	MI
Zip	:	49417-1168
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 3 MILE RD NW STE 200
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49544-1691
Country	:	US
Telephone Number	:	616-212-3012
Fax Number	:

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

Provider Enumeration Date	:	01/08/2026
Last Update Date	:	01/08/2026

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Directions to “ MADISON SMITH ” Practice Location

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