Provider Demographics
NPI:1609564723
Name:GASS, MADISON ROSE
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:ROSE
Last Name:GASS
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 1:104 RILEY DR APT 4
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-2684
Mailing Address - Country:US
Mailing Address - Phone:304-893-4481
Mailing Address - Fax:
Practice Address - Street 1:104 RILEY DR APT 4
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-2684
Practice Address - Country:US
Practice Address - Phone:304-893-4481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator