Healthcare Provider Details

I. General information

NPI: 1508759200
Provider Name (Legal Business Name): MADISON RAE GUZMAN SWC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2025
Last Update Date: 05/31/2025
Certification Date: 05/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 STOVER ST BLDG C
FORT COLLINS CO
80525-4641
US

IV. Provider business mailing address

1832 BEAM REACH PL
FORT COLLINS CO
80524-6725
US

V. Phone/Fax

Practice location:
  • Phone: 970-942-3031
  • Fax:
Mailing address:
  • Phone: 806-891-0324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number0000002480
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: