Provider Demographics
NPI:1710771738
Name:CHASE, MADISON JOHANNA
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:JOHANNA
Last Name:CHASE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 15TH ST SE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55904-5242
Mailing Address - Country:US
Mailing Address - Phone:507-271-4339
Mailing Address - Fax:
Practice Address - Street 1:1470 INDUSTRIAL DR NW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-0700
Practice Address - Country:US
Practice Address - Phone:507-353-3023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician