Provider Demographics
NPI:1790292720
Name:SIRES, MADISON RAY (MA, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:RAY
Last Name:SIRES
Suffix:
Gender:F
Credentials:MA, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1726 15TH AVE APT 18
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-2661
Mailing Address - Country:US
Mailing Address - Phone:425-329-5331
Mailing Address - Fax:
Practice Address - Street 1:1726 15TH AVE APT 18
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-2661
Practice Address - Country:US
Practice Address - Phone:425-329-5331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-29
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBEH-000899103K00000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-22-59002OtherBCBA CERTIFICATE