Provider Demographics
NPI:1699277624
Name:SCROGGIN, MADELEINE ALYSE
Entity type:Individual
Prefix:
First Name:MADELEINE
Middle Name:ALYSE
Last Name:SCROGGIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 IOOF AVE
Mailing Address - Street 2:
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-5204
Mailing Address - Country:US
Mailing Address - Phone:088-462-1004
Mailing Address - Fax:
Practice Address - Street 1:290 IOOF AVE.
Practice Address - Street 2:
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020
Practice Address - Country:US
Practice Address - Phone:408-846-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-06
Last Update Date:2019-11-18
Deactivation Date:2019-02-27
Deactivation Code:
Reactivation Date:2019-03-27
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator