Provider Demographics
NPI:1528602299
Name:MADISON ART THERAPY LLC
Entity Type:Organization
Organization Name:MADISON ART THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/ART THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:TOLTZIEN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, ATR, WATR
Authorized Official - Phone:608-520-0846
Mailing Address - Street 1:700 RAY O VAC DR STE 320
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-2471
Mailing Address - Country:US
Mailing Address - Phone:608-520-0846
Mailing Address - Fax:608-709-1079
Practice Address - Street 1:700 RAY O VAC DR STE 320
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-2471
Practice Address - Country:US
Practice Address - Phone:608-520-0846
Practice Address - Fax:608-709-1079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-05
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt TherapistGroup - Multi-Specialty