Provider Demographics
NPI:1083399406
Name:WITSCHEN, MADISON ROSE (MA, LPC, LADC)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:ROSE
Last Name:WITSCHEN
Suffix:
Gender:F
Credentials:MA, LPC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 E 9TH ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-1608
Mailing Address - Country:US
Mailing Address - Phone:218-780-1728
Mailing Address - Fax:
Practice Address - Street 1:404 W SUPERIOR ST STE 210
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-1569
Practice Address - Country:US
Practice Address - Phone:218-606-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-21
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN305711101YA0400X
MN2819101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)