Provider Demographics
NPI:1346135308
Name:KAO, MADALYN ANNELISE
Entity type:Individual
Prefix:
First Name:MADALYN
Middle Name:ANNELISE
Last Name:KAO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MADALYN
Other - Middle Name:ANNELISE
Other - Last Name:TSUGAWA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2411 EMBLEM ST
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89436-9171
Mailing Address - Country:US
Mailing Address - Phone:775-335-6953
Mailing Address - Fax:
Practice Address - Street 1:4745 CAUGHLIN PKWY
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89519-1010
Practice Address - Country:US
Practice Address - Phone:775-357-8556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-10
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRBT5399106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician