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General NPI Number Information
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NPI Number | 1427513928
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Entity Type | Individual
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Provider Name | MADELINE RAYE SIMONSON LADC
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Gender | Female
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Dates
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Enumeration Date | 02/08/2019
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Last Update Date | 03/12/2025
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Provider Practice Location Address
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Address Line | 10567 165TH ST W
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City | LAKEVILLE
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State | MN
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Zip | 55044-3523
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Country | US
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Telephone | 952-767-9374
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Fax | 262-345-5562
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Provider Business Mailing Address
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Address Line | W175N11120 STONEWOOD DR
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City | GERMANTOWN
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State | WI
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Zip | 53022-6511
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Country | US
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Telephone | 800-438-1772
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Fax | 262-345-5562
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2999
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License Number State | MN
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