Provider Demographics
NPI:1861155681
Name:SLOAN, MADISON NICOLE
Entity type:Individual
Prefix:MRS
First Name:MADISON
Middle Name:NICOLE
Last Name:SLOAN
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 1:3518 W 25TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44109-1995
Mailing Address - Country:US
Mailing Address - Phone:216-741-2241
Mailing Address - Fax:216-459-9821
Practice Address - Street 1:3518 W 25TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109-1995
Practice Address - Country:US
Practice Address - Phone:216-741-2241
Practice Address - Fax:216-459-9821
Is Sole Proprietor?:No
Enumeration Date:2021-10-19
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.181482101YA0400X
OH390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)