Provider Demographics
NPI:1629703640
Name:NOLAND, MADELINE (PHD)
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:
Last Name:NOLAND
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:MADELINE
Other - Middle Name:
Other - Last Name:WIELGUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12039 NE 128TH ST FL 3
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3029
Mailing Address - Country:US
Mailing Address - Phone:425-899-3123
Mailing Address - Fax:
Practice Address - Street 1:12039 NE 128TH ST FL 3
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3029
Practice Address - Country:US
Practice Address - Phone:425-899-3123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-22
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY61100987103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical