Provider Demographics
NPI:1306620505
Name:THORSON, MADISON (MA, BCBA)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:THORSON
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 JEFFERSON ST APT 11
Mailing Address - Street 2:
Mailing Address - City:NORTH LIBERTY
Mailing Address - State:IA
Mailing Address - Zip Code:52317-9098
Mailing Address - Country:US
Mailing Address - Phone:949-870-6034
Mailing Address - Fax:
Practice Address - Street 1:2545 N DODGE ST STE A
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52245-9558
Practice Address - Country:US
Practice Address - Phone:319-727-8202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst