Provider Demographics
NPI:1548979776
Name:RICE, MADELINE
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:
Last Name:RICE
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 1:401 W BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:INGALLS
Mailing Address - State:IN
Mailing Address - Zip Code:46048-9500
Mailing Address - Country:US
Mailing Address - Phone:585-808-2650
Mailing Address - Fax:
Practice Address - Street 1:401 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:INGALLS
Practice Address - State:IN
Practice Address - Zip Code:46048-9500
Practice Address - Country:US
Practice Address - Phone:585-808-2650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-16
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst