=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902584774
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MADISON YOULDEN SWLC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/10/2023
-----------------------------------------------------
Last Update Date | 07/10/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 42 HILLTOP RD
-----------------------------------------------------
City | BILLINGS
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59105-2351
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-413-5815
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 300 N WILLSON AVE STE 3005-10
-----------------------------------------------------
City | BOZEMAN
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59715-3537
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-281-0253
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 64089
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------