Provider Demographics
NPI:1568080554
Name:DOFELMIRE, MADISON ELOISE
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:ELOISE
Last Name:DOFELMIRE
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 1:4606 108TH ST SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-4146
Mailing Address - Country:US
Mailing Address - Phone:253-693-2626
Mailing Address - Fax:
Practice Address - Street 1:4606 108TH ST SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-4146
Practice Address - Country:US
Practice Address - Phone:253-693-2626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-07
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst