Individual
MADELYN VICKERY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
12313 US HIGHWAY 301 S, STATESBORO, GA 30458-3218
(800) 844-1232
Mailing address
975 W HAWTHORN DR, ITASCA, IL 60143-2056
(800) 844-1232
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
12363982
GA
Other
Enumeration date
01/19/2023
Last updated
11/01/2023
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