Provider Demographics
NPI:1104653682
Name:FRITTS, MADISON ROSE
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:ROSE
Last Name:FRITTS
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 1:237 GEORGE LEWIS CT
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:OH
Mailing Address - Zip Code:45030-4919
Mailing Address - Country:US
Mailing Address - Phone:513-629-0716
Mailing Address - Fax:
Practice Address - Street 1:237 GEORGE LEWIS CT
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:OH
Practice Address - Zip Code:45030-4919
Practice Address - Country:US
Practice Address - Phone:513-629-0716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician