Provider Demographics
NPI:1528741857
Name:MADRO, TYLER (MS, LPC-IT)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:MADRO
Suffix:
Gender:M
Credentials:MS, LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5018 SIGGELKOW RD APT 202
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53718-7018
Mailing Address - Country:US
Mailing Address - Phone:815-701-8699
Mailing Address - Fax:
Practice Address - Street 1:211 S PATERSON ST STE 370
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-4501
Practice Address - Country:US
Practice Address - Phone:608-535-1095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-11
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7358-226101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health