Provider Demographics
NPI:1174270730
Name:DELISLE, MADELEINE
Entity Type:Individual
Prefix:
First Name:MADELEINE
Middle Name:
Last Name:DELISLE
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 1:248 NE BARRY RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64155-2722
Mailing Address - Country:US
Mailing Address - Phone:816-608-1957
Mailing Address - Fax:
Practice Address - Street 1:248 NE BARRY RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64155-2722
Practice Address - Country:US
Practice Address - Phone:816-608-1957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-03
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician