Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 16334 | MN |
NPI | 1003095027 |
---|---|
Provider Name | Alissa Leigh Madden |
First Address | Woodbury, MN 55125-2272 |
Second Address | Woodbury, MN 55125-2272 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2007 |
Last Update Date | 25/10/2007 |