Healthcare Provider Details

I. General information

NPI: 1801209010
Provider Name (Legal Business Name): MARTHA V SAUCEDO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2014
Last Update Date: 01/19/2021
Certification Date: 01/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2202 S PARK ST
MADISON WI
53713-1916
US

IV. Provider business mailing address

2901 W BELTLINE HWY SUITE 120
MADISON WI
53713-4226
US

V. Phone/Fax

Practice location:
  • Phone: 608-443-5480
  • Fax: 608-443-5534
Mailing address:
  • Phone: 608-443-5500
  • Fax: 608-441-2385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8176
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: