Provider Demographics
NPI:1578187985
Name:ECK, MADALINE SHIPLEY
Entity Type:Individual
Prefix:
First Name:MADALINE
Middle Name:SHIPLEY
Last Name:ECK
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 1:77 S OAKBRIDGE CT APT 214
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53717-2034
Mailing Address - Country:US
Mailing Address - Phone:414-617-3718
Mailing Address - Fax:
Practice Address - Street 1:414 DONOFRIO DR STE 330
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-2846
Practice Address - Country:US
Practice Address - Phone:608-236-4460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-01
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health