Provider Demographics
NPI:1639748148
Name:WHITLEY, MADISON (MA, BCBA, COBA)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:WHITLEY
Suffix:
Gender:F
Credentials:MA, BCBA, COBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1216 BARKER BLVD APT A
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-8618
Mailing Address - Country:US
Mailing Address - Phone:910-787-7466
Mailing Address - Fax:
Practice Address - Street 1:6960 S EDGERTON RD
Practice Address - Street 2:
Practice Address - City:BRECKSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44141-3184
Practice Address - Country:US
Practice Address - Phone:440-241-8366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-18
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
OH1-22-62073103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician