Healthcare Provider Details

I. General information

NPI: 1578344719
Provider Name (Legal Business Name): MADISON THOMPSON BSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2023
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 DOUGLAS DR
CARBONDALE IL
62901-2586
US

IV. Provider business mailing address

1220 DOUGLAS DR
CARBONDALE IL
62901-2586
US

V. Phone/Fax

Practice location:
  • Phone: 618-453-7482
  • Fax:
Mailing address:
  • Phone: 618-453-7482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: