Individual
MATHEW DELL MADSEN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
750 N FREEDOM BLVD, PROVO, UT 84601-1677
(801) 373-4760
Mailing address
750 N FREEDOM BLVD, PROVO, UT 84601-1677
(801) 373-4760
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
141569-3501
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005742637
—
UT
Enumeration date
10/03/2006
Last updated
07/08/2007
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