Healthcare Provider Details

I. General information

NPI: 1598595506
Provider Name (Legal Business Name): MADELINE KAE MOLEN MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2024
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3075 N MAIN ST
SPANISH FORK UT
84660-9506
US

IV. Provider business mailing address

750 N FREEDOM BLVD
PROVO UT
84601-1677
US

V. Phone/Fax

Practice location:
  • Phone: 801-851-7689
  • Fax:
Mailing address:
  • Phone: 801-373-4760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number12437883-3502
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: