Healthcare Provider Details

I. General information

NPI: 1538730031
Provider Name (Legal Business Name): MADISON M SIDWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2021
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1288 VALLEY FORGE RD STE 54
PHOENIXVILLE PA
19460-2687
US

IV. Provider business mailing address

1100 E PROSPECT RD BLDG A
FORT COLLINS CO
80525-5304
US

V. Phone/Fax

Practice location:
  • Phone: 267-563-8180
  • Fax:
Mailing address:
  • Phone: 970-297-6630
  • Fax: 970-297-6631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberCSW.09931884
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW139725
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: