Provider Demographics
NPI:1548776909
Name:MUSSON, MADISON ROSEANN RIDDLE (MA, LMFT, ATR-BC)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:ROSEANN RIDDLE
Last Name:MUSSON
Suffix:
Gender:F
Credentials:MA, LMFT, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4949 PLEASANT ST STE 202
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-5495
Mailing Address - Country:US
Mailing Address - Phone:206-588-5550
Mailing Address - Fax:
Practice Address - Street 1:4949 PLEASANT ST STE 202
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-5495
Practice Address - Country:US
Practice Address - Phone:206-588-5550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-21
Last Update Date:2023-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMFT.0001952106H00000X
IA17-539221700000X
CO17-539221700000X
IA084849106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist