Provider Demographics
NPI:1578388591
Name:REEDER, MADISON LEA
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:LEA
Last Name:REEDER
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 1:4320 N 81ST ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-3202
Mailing Address - Country:US
Mailing Address - Phone:402-706-9476
Mailing Address - Fax:
Practice Address - Street 1:4320 N 81ST ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68134-3202
Practice Address - Country:US
Practice Address - Phone:402-706-9476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-15
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEBACB1216691106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician