Individual
TYLEETA J MADISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CDCA
Contact information
Practice address
2115 W PARK DR, LORAIN, OH 44053-1138
(440) 989-4900
(440) 282-4779
Mailing address
2115 W PARK DR, LORAIN, OH 44053-1138
(440) 989-4900
(440) 282-4779
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
CDCA.171102
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CDCA.171102
LICENSE
OH
Enumeration date
10/22/2019
Last updated
10/22/2019
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