Provider Demographics
NPI:1235612672
Name:BERRIDGE, MADISON VICTORIA
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:VICTORIA
Last Name:BERRIDGE
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 1:7922 E DOGWOOD MEADOWS CT SE
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:MI
Mailing Address - Zip Code:49301-9440
Mailing Address - Country:US
Mailing Address - Phone:517-898-7328
Mailing Address - Fax:
Practice Address - Street 1:7922 E DOGWOOD MEADOWS CT SE
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:MI
Practice Address - Zip Code:49301-9440
Practice Address - Country:US
Practice Address - Phone:517-898-7328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-12
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician