Provider Demographics
NPI:1659189207
Name:BUCKINGHAM, MADALYNN
Entity type:Individual
Prefix:
First Name:MADALYNN
Middle Name:
Last Name:BUCKINGHAM
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 1:2101 W ENTERPRISE AVE
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-5839
Mailing Address - Country:US
Mailing Address - Phone:765-896-7140
Mailing Address - Fax:
Practice Address - Street 1:918 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:IN
Practice Address - Zip Code:47394-9276
Practice Address - Country:US
Practice Address - Phone:765-896-7140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-27
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician