Provider Demographics
NPI:1154198984
Name:SHRIVER, MADALYN BRIDGET SLIETER (LMFT)
Entity type:Individual
Prefix:MRS
First Name:MADALYN
Middle Name:BRIDGET SLIETER
Last Name:SHRIVER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:548 S TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218-2236
Mailing Address - Country:US
Mailing Address - Phone:316-461-3668
Mailing Address - Fax:
Practice Address - Street 1:731 N MCLEAN BLVD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-4986
Practice Address - Country:US
Practice Address - Phone:316-461-0339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS03394106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist