MEDICARE: MADELEINE BROOKE CARLSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DENT.DE.70123883	WA

General Provider Information

NPI Number	:	1528904588
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADELEINE BROOKE CARLSON

Provider Business Mailing Address
First Line	:	6728 126TH ST SE
Second Line	:
City	:	SNOHOMISH
State	:	WA
Zip	:	98296-8652
Country	:	US
Telephone Number	:	425-299-5393
Fax Number	:

Provider Business Practice Location Address
First Line	:	14650 N KELSEY ST
Second Line	:
City	:	MONROE
State	:	WA
Zip	:	98272-1456
Country	:	US
Telephone Number	:	360-467-6386
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/23/2026
Last Update Date	:	04/23/2026

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Directions to “ MADELEINE BROOKE CARLSON ” Practice Location

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