MEDICARE: MADELINE COLFORD LICSW

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

General Provider Information

NPI Number	:	1336858455
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADELINE COLFORD LICSW

Provider Business Mailing Address
First Line	:	14050 NICOLLET AVE STE 301
Second Line	:
City	:	BURNSVILLE
State	:	MN
Zip	:	55337-5739
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	14050 NICOLLET AVE STE 301
Second Line	:
City	:	BURNSVILLE
State	:	MN
Zip	:	55337-5739
Country	:	US
Telephone Number	:	612-568-7319
Fax Number	:

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

Provider Enumeration Date	:	11/17/2022
Last Update Date	:	02/28/2023

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Directions to “ MADELINE COLFORD LICSW” Practice Location

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