Provider Demographics
NPI:1134592140
Name:ESPESETH, MADDISEN (PSYD)
Entity type:Individual
Prefix:DR
First Name:MADDISEN
Middle Name:
Last Name:ESPESETH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 S IMPERIAL HWY
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-3943
Mailing Address - Country:US
Mailing Address - Phone:714-790-4066
Mailing Address - Fax:
Practice Address - Street 1:136 S IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-3943
Practice Address - Country:US
Practice Address - Phone:714-790-4066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-12
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY32949103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical