Active NPI
Madison Ossewaarde
- Behavior Technician
- Niles, MI
National Provider Identifier
1477393916
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- 12148482
- Practice address
- 2753 S 11TH St
Niles, MI 49120-4419 - Phone
- (574) 387-4313
- Fax
- (574) 204-2868
- NPI assigned
- May 31, 2024
- Last updated
- May 31, 2024
- 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 |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | 12148482 | MI | Primary |
Addresses
Primary practice location
2753 S 11TH St
Niles, MI 49120-4419
Mailing address
215 Red Coach Dr
Mishawaka, IN 46545-8307
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12148482 | MI | MD | Behavior Technician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Vav Operations Mi, LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Lighthouse Autism Center - MI
- Community/Behavioral Health Agency
- Kalamazoo, MI
- NPI 1285174912
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1717113600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1717113600000",
"number": "1477393916",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "215 RED COACH DR",
"city": "MISHAWAKA",
"state": "IN",
"postal_code": "465458307"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2753 S 11TH ST",
"city": "NILES",
"state": "MI",
"postal_code": "491204419",
"telephone_number": "574-387-4313",
"fax_number": "574-204-2868"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OSSEWAARDE",
"first_name": "MADISON",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-05-31",
"last_updated": "2024-05-31",
"certification_date": "2024-05-31",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "MI",
"license": "12148482",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Niles, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.