Provider Demographics
NPI:1689397911
Name:DUENO, MADISON LEA
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:LEA
Last Name:DUENO
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 1:2424 HERITAGE CT SW STE 200
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-6046
Mailing Address - Country:US
Mailing Address - Phone:360-810-2276
Mailing Address - Fax:
Practice Address - Street 1:2424 HERITAGE CT SW STE 200
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-6046
Practice Address - Country:US
Practice Address - Phone:360-810-2276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician