Provider Demographics
NPI:1902485261
Name:MACEY, MADISON O'GRADY (MS, RD)
Entity Type:Individual
Prefix:MRS
First Name:MADISON
Middle Name:O'GRADY
Last Name:MACEY
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:O'GRADY
Other - Last Name:BENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7906 148TH STREET CT E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98375-8431
Mailing Address - Country:US
Mailing Address - Phone:253-720-3661
Mailing Address - Fax:
Practice Address - Street 1:7906 148TH STREET CT E
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98375-8431
Practice Address - Country:US
Practice Address - Phone:253-720-3661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-05
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA86167950133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered