Provider Demographics
NPI:1376924852
Name:CONRAD, MADELINE (LICSW)
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:
Last Name:CONRAD
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:MADELINE
Other - Middle Name:ELEANORE
Other - Last Name:TOLKAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4432 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-3540
Mailing Address - Country:US
Mailing Address - Phone:612-801-9184
Mailing Address - Fax:
Practice Address - Street 1:4432 PARK AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-3540
Practice Address - Country:US
Practice Address - Phone:612-801-9184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-10
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN140731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical