Provider Demographics
NPI:1093419467
Name:RUPE, MADISEN ASHLEY (RBT)
Entity type:Individual
Prefix:
First Name:MADISEN
Middle Name:ASHLEY
Last Name:RUPE
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 OLD VINES TRL
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-3412
Mailing Address - Country:US
Mailing Address - Phone:317-533-3507
Mailing Address - Fax:317-497-0254
Practice Address - Street 1:1217 OLD VINES TRL
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-3412
Practice Address - Country:US
Practice Address - Phone:317-520-4748
Practice Address - Fax:888-498-5529
Is Sole Proprietor?:No
Enumeration Date:2023-03-29
Last Update Date:2025-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INRBT-22-249147106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician