Provider Demographics
NPI:1548073984
Name:CLODFELTER, MADISON M
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:M
Last Name:CLODFELTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 ROLLING RIVER RD
Mailing Address - Street 2:
Mailing Address - City:LONGS
Mailing Address - State:SC
Mailing Address - Zip Code:29568-9498
Mailing Address - Country:US
Mailing Address - Phone:704-550-8004
Mailing Address - Fax:
Practice Address - Street 1:80 ROLLING RIVER RD
Practice Address - Street 2:
Practice Address - City:LONGS
Practice Address - State:SC
Practice Address - Zip Code:29568-9498
Practice Address - Country:US
Practice Address - Phone:704-550-8004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician