Provider Demographics
NPI:1952026353
Name:CLABOUGH, MADISON VICTORIA
Entity type:Individual
Prefix:MISS
First Name:MADISON
Middle Name:VICTORIA
Last Name:CLABOUGH
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 1:6722 MALONE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37931-3402
Mailing Address - Country:US
Mailing Address - Phone:865-328-0843
Mailing Address - Fax:
Practice Address - Street 1:6722 MALONE CREEK DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37931-3402
Practice Address - Country:US
Practice Address - Phone:865-328-0843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-07
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician