Healthcare Provider Details

I. General information

NPI: 1205761087
Provider Name (Legal Business Name): MADISON J RHODES LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1309 CAMAS ST
BLACKFOOT ID
83221-3060
US

IV. Provider business mailing address

1355 PENDLEBURY LN
BLACKFOOT ID
83221-3642
US

V. Phone/Fax

Practice location:
  • Phone: 208-782-0675
  • Fax:
Mailing address:
  • Phone: 208-604-8361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number9861763
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: