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NPI Code Detail

MEDICARE: MADISON GRACE CONRAD

MEDICARE: MADISON GRACE CONRAD
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 : 1720910185
Entity Type Code : Individual
Provider Name (Legal Business Name) : MADISON GRACE CONRAD
Provider Business Mailing Address
First Line : 1742 CROOKS RD
Second Line :
City : TROY
State : MI
Zip : 48084-5501
Country : US
Telephone Number : 248-544-0360
Fax Number : 248-544-0388
Provider Business Practice Location Address
First Line : 1742 CROOKS RD
Second Line :
City : TROY
State : MI
Zip : 48084-5501
Country : US
Telephone Number : 248-544-0360
Fax Number : 248-544-0388
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2026
Last Update Date : 06/01/2026

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Directions to “ MADISON GRACE CONRAD ” Practice Location

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