Provider Demographics
NPI:1174312490
Name:WINGATE, MADISON
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:WINGATE
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 1:1900 OAKDALE RD APT 29
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-2978
Mailing Address - Country:US
Mailing Address - Phone:209-276-5634
Mailing Address - Fax:
Practice Address - Street 1:1700 MCHENRY VILLAGE WAY STE 11B
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4341
Practice Address - Country:US
Practice Address - Phone:209-213-7995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-02
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator