Provider Demographics
NPI:1225693062
Name:GUERRA, MADDISON JEAN (LMSW)
Entity Type:Individual
Prefix:
First Name:MADDISON
Middle Name:JEAN
Last Name:GUERRA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KS
Mailing Address - Zip Code:67831-0188
Mailing Address - Country:US
Mailing Address - Phone:620-635-3138
Mailing Address - Fax:
Practice Address - Street 1:625 KENTUCKY ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KS
Practice Address - Zip Code:67831-3199
Practice Address - Country:US
Practice Address - Phone:620-635-3138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-07
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13066104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker