Provider Demographics
NPI:1730673682
Name:MADRONA, KIM ALLISON
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:ALLISON
Last Name:MADRONA
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 1:3343 PARKS AVE
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274-7466
Mailing Address - Country:US
Mailing Address - Phone:559-827-2451
Mailing Address - Fax:
Practice Address - Street 1:426 N BLACKSTONE ST
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-4449
Practice Address - Country:US
Practice Address - Phone:559-688-2021
Practice Address - Fax:559-687-7317
Is Sole Proprietor?:No
Enumeration Date:2018-06-14
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
CA240089940101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst