{
"Npi": {
"NPI": "1538730031",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "SIDWELL",
"FirstName": "MADISON",
"MiddleName": "M",
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1100 E PROSPECT RD BLDG A",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FORT COLLINS",
"MailingAddressStateName": "CO",
"MailingAddressPostalCode": "80525-5304",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "970-297-6630",
"MailingAddressFaxNumber": "970-297-6631",
"FirstLinePracticeLocationAddress": "1288 VALLEY FORGE RD STE 54",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PHOENIXVILLE",
"PracticeLocationAddressStateName": "PA",
"PracticeLocationAddressPostalCode": "19460-2687",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "267-563-8180",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "07/06/2021",
"LastUpdateDate": "12/15/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "104100000X",
"TaxonomyName": "Social Worker",
"LicenseNumber": "CSW.09931884",
"LicenseNumberStateCode": "CO",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "104100000X",
"TaxonomyName": "Social Worker",
"LicenseNumber": "SW139725",
"LicenseNumberStateCode": "PA",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}