Healthcare Provider Details

I. General information

NPI: 1366349359
Provider Name (Legal Business Name): MADELYN GEFRE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2026
Last Update Date: 10/22/2026
Certification Date: 10/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 28TH ST S
FARGO ND
58103-8700
US

IV. Provider business mailing address

1202 28TH ST S
FARGO ND
58103-8700
US

V. Phone/Fax

Practice location:
  • Phone: 701-280-9545
  • Fax:
Mailing address:
  • Phone: 701-280-9545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1553-6-15-26A
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: