Provider Demographics
NPI:1568845808
Name:SWEET, MADISON ALICIA (LISW)
Entity Type:Individual
Prefix:MRS
First Name:MADISON
Middle Name:ALICIA
Last Name:SWEET
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:ALICIA
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW
Mailing Address - Street 1:10542 JUSTIN DR
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-3730
Mailing Address - Country:US
Mailing Address - Phone:515-344-4148
Mailing Address - Fax:
Practice Address - Street 1:10542 JUSTIN DR
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-3730
Practice Address - Country:US
Practice Address - Phone:515-344-4148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA076887104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0711185Medicaid
IA1568845808OtherWELLMARK BCBS IA