Provider Demographics
NPI:1740848274
Name:MADISON AREA MUSIC THERAPY, LLC
Entity type:Organization
Organization Name:MADISON AREA MUSIC THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, MUSIC THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:RIECKHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MT-BC, WMTR
Authorized Official - Phone:715-370-8262
Mailing Address - Street 1:1316 SWORDLEAF LN
Mailing Address - Street 2:
Mailing Address - City:SUN PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53590-4317
Mailing Address - Country:US
Mailing Address - Phone:715-370-8262
Mailing Address - Fax:
Practice Address - Street 1:1316 SWORDLEAF LN
Practice Address - Street 2:
Practice Address - City:SUN PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53590-4317
Practice Address - Country:US
Practice Address - Phone:715-370-8262
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-30
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
12505OtherCERTIFICATION BOARD FOR MUSIC THERAPISTS
WI149-38OtherSTATE OF WI DEPARTMENT OF SAFETY AND PROFESSIONAL SERVICES