Healthcare Provider Details

I. General information

NPI: 1871313973
Provider Name (Legal Business Name): MADISON LYNNE KRAUSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2024
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 52ND AVE
MOLINE IL
61265-6308
US

IV. Provider business mailing address

9 BLACKHAWK HILLS CT
ROCK ISLAND IL
61201-6935
US

V. Phone/Fax

Practice location:
  • Phone: 309-797-2900
  • Fax:
Mailing address:
  • Phone: 309-716-6001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149041259
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: