Healthcare Provider Details

I. General information

NPI: 1295647048
Provider Name (Legal Business Name): MADISON TAYLOR SWAIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 MCKNIGHT RD N APT 301
SAINT PAUL MN
55119-6601
US

IV. Provider business mailing address

169 MCKNIGHT RD N APT 301
SAINT PAUL MN
55119-6601
US

V. Phone/Fax

Practice location:
  • Phone: 952-220-2956
  • Fax:
Mailing address:
  • Phone: 952-220-2956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: