Provider Demographics
NPI:1740923200
Name:MADISON, BRYIA
Entity type:Individual
Prefix:
First Name:BRYIA
Middle Name:
Last Name:MADISON
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 1:15401 NE TURING ST APT 521
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-5352
Mailing Address - Country:US
Mailing Address - Phone:425-802-4057
Mailing Address - Fax:
Practice Address - Street 1:15401 NE TURING ST APT 521
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-5352
Practice Address - Country:US
Practice Address - Phone:425-802-4057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-13
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist