Provider Demographics
NPI:1871640128
Name:MADISON, LYNDA S (PHD)
Entity Type:Individual
Prefix:DR
First Name:LYNDA
Middle Name:S
Last Name:MADISON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4917 UNDERWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68132-2421
Mailing Address - Country:US
Mailing Address - Phone:402-740-7718
Mailing Address - Fax:
Practice Address - Street 1:4917 UNDERWOOD AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68132-2421
Practice Address - Country:US
Practice Address - Phone:402-740-7718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE153103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE8129OtherBCBS
3029OtherMIDLANDS CHOICE
NE49405Medicaid
6135830OtherUNITED BEHAVIORAL HEALTH