Healthcare Provider Details

I. General information

NPI: 1225693062
Provider Name (Legal Business Name): MADDISON JEAN CORTES LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2019
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 KENTUCKY ST
ASHLAND KS
67831-3199
US

IV. Provider business mailing address

PO BOX 188
ASHLAND KS
67831-0188
US

V. Phone/Fax

Practice location:
  • Phone: 620-635-3138
  • Fax:
Mailing address:
  • Phone: 620-635-3138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number13066
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: