Healthcare Provider Details

I. General information

NPI: 1780343186
Provider Name (Legal Business Name): MADISON TAYLOR FOERDERER LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2021
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2324 UNIVERSITY AVE W STE 120
SAINT PAUL MN
55114-1854
US

IV. Provider business mailing address

1115 ELWAY ST APT 312
SAINT PAUL MN
55116-3246
US

V. Phone/Fax

Practice location:
  • Phone: 651-644-4100
  • Fax:
Mailing address:
  • Phone: 952-266-9365
  • 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: