Provider Demographics
NPI:1215734082
Name:VAN BUSKIRK, MADISON ABIGAIL
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:ABIGAIL
Last Name:VAN BUSKIRK
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 E ARROWHEAD LN
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-5232
Mailing Address - Country:US
Mailing Address - Phone:385-246-5845
Mailing Address - Fax:
Practice Address - Street 1:1537 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84115-5315
Practice Address - Country:US
Practice Address - Phone:385-777-9444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14007999-35021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical