Provider Demographics
NPI:1396549937
Name:VANBURKLEO, MADISON FAYE
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:FAYE
Last Name:VANBURKLEO
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 1:6207 E IRONHORSE ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67220-5516
Mailing Address - Country:US
Mailing Address - Phone:316-616-5549
Mailing Address - Fax:
Practice Address - Street 1:8100 E 22ND ST N STE 100
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-2350
Practice Address - Country:US
Practice Address - Phone:316-201-4390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-02
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLMSW12282104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker