MEDICARE: JULIE MADGWICK LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	01999-C	NV

General Provider Information

NPI Number	:	1104845130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE MADGWICK LCSW

Provider Business Mailing Address
First Line	:	7473 W LAKE MEAD BLVD
Second Line	:	STE 100
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0265
Country	:	US
Telephone Number	:	702-947-4841
Fax Number	:	702-562-1247

Provider Business Practice Location Address
First Line	:	7473 W LAKE MEAD BLVD
Second Line	:	STE 100
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0265
Country	:	US
Telephone Number	:	702-947-4841
Fax Number	:	702-562-1201

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	06/26/2018

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