Provider Demographics
NPI:1760850929
Name:MADIGAN, MARGARET A (LAC)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:A
Last Name:MADIGAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 N HILLSIDE ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-4935
Mailing Address - Country:US
Mailing Address - Phone:316-558-3066
Mailing Address - Fax:316-558-3067
Practice Address - Street 1:212 N HILLSIDE ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-4935
Practice Address - Country:US
Practice Address - Phone:316-558-3066
Practice Address - Fax:316-558-3067
Is Sole Proprietor?:No
Enumeration Date:2015-09-04
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS326101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS2600604120AMedicaid