Healthcare Provider Details

I. General information

NPI: 1700771409
Provider Name (Legal Business Name): ANGELA MADEUX CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2025
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 N MAIN ST STE 205
ST GEORGE UT
84770-5591
US

IV. Provider business mailing address

621 E ELMBROOK DR
WASHINGTON UT
84780-3649
US

V. Phone/Fax

Practice location:
  • Phone: 435-879-7411
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14220717-3502
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: