Healthcare Provider Details

I. General information

NPI: 1083399406
Provider Name (Legal Business Name): MADISON ROSE WITSCHEN MA, LPCC, LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2023
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 MINNESOTA ST STE 1500
SAINT PAUL MN
55101-2269
US

IV. Provider business mailing address

305 CENTRAL AVE W
AURORA MN
55705-1259
US

V. Phone/Fax

Practice location:
  • Phone: 646-453-6777
  • Fax:
Mailing address:
  • Phone: 218-780-1728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number305711
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4131
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: