Madelyn Vickery, BCBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

12363982 Issued in GA

Practice address

12313 US Highway 301 S
Statesboro, GA 30458-3218

Phone

(800) 844-1232

NPI assigned

Jan 19, 2023

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Chicago Autism and Behavior Specialists

  • Behavior Analyst
  • Itasca, IL
  • NPI 1295021269
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1674086400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698796800000",
    "number": "1154036572",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "975 W HAWTHORN DR",
            "city": "ITASCA",
            "state": "IL",
            "postal_code": "601432056",
            "telephone_number": "800-844-1232"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12313 US HIGHWAY 301 S",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "304583218",
            "telephone_number": "800-844-1232"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "30 Park Of Commerce Way Ste 100",
            "address_purpose": "LOCATION",
            "city": "Savannah",
            "state": "GA",
            "postal_code": "314051358",
            "country_code": "US",
            "telephone_number": "800-844-1232",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VICKERY",
        "first_name": "MADELYN",
        "credential": "BCBA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-01-19",
        "last_updated": "2023-11-01",
        "certification_date": "2023-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "GA",
            "license": "12363982",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Behavior Analyst in Statesboro, GA
• Providers in Statesboro, GA by specialty
• Behavior Analyst in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.