Individual
MADISON ILLIDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
140 3RD AVE, ALPHA, NJ 08865-4306
(908) 940-1382
Mailing address
3403 GLEN AVE, EASTON, PA 18045-5929
(347) 820-0103
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
03/12/2025
Last updated
03/12/2025
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