Provider Demographics
NPI:1073315222
Name:FOSS-CORMIER, MADDISON
Entity type:Individual
Prefix:
First Name:MADDISON
Middle Name:
Last Name:FOSS-CORMIER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 ENDL AVE
Mailing Address - Street 2:
Mailing Address - City:FORT NOVOSEL
Mailing Address - State:AL
Mailing Address - Zip Code:36362-2241
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1566 ANDREWS AVE
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:AL
Practice Address - Zip Code:36360-3718
Practice Address - Country:US
Practice Address - Phone:334-443-1043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician