Healthcare Provider Details

I. General information

NPI: 1700336831
Provider Name (Legal Business Name): MADELIN MARIE WINOGRAD MFTI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2016
Last Update Date: 06/25/2021
Certification Date: 06/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 MARKET ST
REDDING CA
96001-1021
US

IV. Provider business mailing address

2521 HILLTOP DR. PMB 120
REDDING CA
96002-0519
US

V. Phone/Fax

Practice location:
  • Phone: 530-225-5969
  • Fax:
Mailing address:
  • Phone: 530-223-3019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT95479
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: