MEDICARE: MADISON WILLIAMS

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	1041S0200X	School Social Worker	24625	MN

General Provider Information

NPI Number	:	1780529800
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADISON WILLIAMS

Provider Business Mailing Address
First Line	:	275 LEXINGTON PKWY N
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55104-5402
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	275 LEXINGTON PKWY N
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55104-5402
Country	:	US
Telephone Number	:	651-744-5005
Fax Number	:

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

Provider Enumeration Date	:	04/23/2026
Last Update Date	:	04/23/2026

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