Provider Demographics
NPI:1760143945
Name:SUDON, MADISON MARISSA
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:MARISSA
Last Name:SUDON
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 1:4707 WOODHURST DR APT 6
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-3747
Mailing Address - Country:US
Mailing Address - Phone:330-774-7199
Mailing Address - Fax:
Practice Address - Street 1:29 NORTH RD
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:OH
Practice Address - Zip Code:44446-1918
Practice Address - Country:US
Practice Address - Phone:330-652-6770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-10
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)