Provider Demographics
NPI:1215202940
Name:MADIGAN, MICHELLE JEANNE (BSHS/M)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:JEANNE
Last Name:MADIGAN
Suffix:
Gender:F
Credentials:BSHS/M
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:349 W PINE ST APT 5C
Mailing Address - Street 2:
Mailing Address - City:CENTRAL POINT
Mailing Address - State:OR
Mailing Address - Zip Code:97502-1966
Mailing Address - Country:US
Mailing Address - Phone:541-217-8718
Mailing Address - Fax:
Practice Address - Street 1:715 SW RAMSEY AVE
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97527-5500
Practice Address - Country:US
Practice Address - Phone:541-956-4943
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker