Provider Demographics
NPI:1295778827
Name:MADRIGAL, DANIEL R
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:R
Last Name:MADRIGAL
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:DANIEL
Other - Middle Name:R
Other - Last Name:MADRIGAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:PO BOX 7023
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73506-1023
Mailing Address - Country:US
Mailing Address - Phone:580-536-5067
Mailing Address - Fax:
Practice Address - Street 1:4101 S 4TH ST TRAFFIC WAY
Practice Address - Street 2:VA EASTERN KANSAS HEALTHCARE SYSTEM
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:73506
Practice Address - Country:US
Practice Address - Phone:913-682-2000
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK24641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK2464OtherOK. LICENSE NUMBER