Provider Demographics
NPI:1811744949
Name:MADISON, FRANKIE
Entity type:Individual
Prefix:
First Name:FRANKIE
Middle Name:
Last Name:MADISON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6614 SOUTHERN BLVD BLDG E
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-3455
Mailing Address - Country:US
Mailing Address - Phone:330-746-8056
Mailing Address - Fax:
Practice Address - Street 1:6614 SOUTHERN BLVD BLDG E
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-3455
Practice Address - Country:US
Practice Address - Phone:330-746-8056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.24053431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical