Active NPI
Madison Bennett
- Behavior Technician
- Southfield, MI
National Provider Identifier
1366230310
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- Practice address
- 1115 Ball Ave NE
Grand Rapids, MI 49505-5904 - Phone
- (616) 456-6571
- NPI assigned
- Apr 29, 2025
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | MI | Primary |
Addresses
Primary practice location
1115 Ball Ave NE
Grand Rapids, MI 49505-5904
Mailing address
1115 Ball Ave NE
Grand Rapids, MI 49505-5904
Phone (616) 456-6571
Other names 1
- Madison Bennett
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1745884800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1789344000000",
"number": "1366230310",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1115 BALL AVE NE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495055904",
"telephone_number": "616-456-6571"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1115 BALL AVE NE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495055904",
"telephone_number": "616-456-6571"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLUM",
"first_name": "MADISON",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-04-29",
"last_updated": "2026-09-14",
"certification_date": "2026-09-14",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "MI",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "MADISON",
"last_name": "BENNETT",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Southfield, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.