Provider Demographics
NPI:1154560738
Name:MADSEN, KAY ANNETTE (MAC, LAC)
Entity type:Individual
Prefix:
First Name:KAY
Middle Name:ANNETTE
Last Name:MADSEN
Suffix:
Gender:F
Credentials:MAC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13415 CONNECTICUT AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-2910
Mailing Address - Country:US
Mailing Address - Phone:301-922-6036
Mailing Address - Fax:301-929-0136
Practice Address - Street 1:13415 CONNECTICUT AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-2910
Practice Address - Country:US
Practice Address - Phone:301-922-6036
Practice Address - Fax:301-929-0136
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-05
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01197171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist