Individual
ANDREA MADSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
113 S APPLE ST, SHOSHONE, ID 83352-5287
(208) 886-2224
Mailing address
113 S APPLE ST, SHOSHONE, ID 83352-5287
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
LMSW-35813
ID
101YA0400X
Addiction (Substance Use Disorder) Counselor
LMSW-35813
ID
101YM0800X
Mental Health Counselor
LMSW-35813
ID
104100000X
Social Worker
Primary
LMSW-35813
ID
1041S0200X
School Social Worker
LMSW-35813
ID
Other
Enumeration date
06/28/2016
Last updated
06/28/2016
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