Provider Demographics
NPI:1568209054
Name:MADISON, LINDSEY PALLAS (BCBA)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:PALLAS
Last Name:MADISON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 NE AMBERLY LN
Mailing Address - Street 2:
Mailing Address - City:WAUKEE
Mailing Address - State:IA
Mailing Address - Zip Code:50263-1286
Mailing Address - Country:US
Mailing Address - Phone:952-594-2563
Mailing Address - Fax:
Practice Address - Street 1:710 NE AMBERLY LN
Practice Address - Street 2:
Practice Address - City:WAUKEE
Practice Address - State:IA
Practice Address - Zip Code:50263-1286
Practice Address - Country:US
Practice Address - Phone:952-594-2563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IABA-01023103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst