Individual
MADISON NICOLE UDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BSHA, CDP, QIDP
Contact information
Practice address
1011 S GRAND AVE W, SPRINGFIELD, IL 62704-3550
(801) 592-5375
Mailing address
1011 S GRAND AVE W, SPRINGFIELD, IL 62704-3550
(217) 725-1851
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
251B00000X
Case Management Agency
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
253Z00000X
In Home Supportive Care Agency
Primary
—
—
376J00000X
Homemaker
—
—
385H00000X
Respite Care
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
Other
Enumeration date
04/05/2023
Last updated
05/30/2025
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