Provider Demographics
NPI:1477610525
Name:MADSEN, INGRID ELIZABETH (LCPC)
Entity Type:Individual
Prefix:
First Name:INGRID
Middle Name:ELIZABETH
Last Name:MADSEN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 W PARK PL STE 306
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2784
Mailing Address - Country:US
Mailing Address - Phone:208-667-3383
Mailing Address - Fax:888-765-5414
Practice Address - Street 1:1110 W PARK PL STE 306
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2784
Practice Address - Country:US
Practice Address - Phone:208-667-3383
Practice Address - Fax:208-765-5082
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC3395101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health