Provider Demographics
NPI:1578313920
Name:BEHRENS, MADISYN (LMSW)
Entity Type:Individual
Prefix:
First Name:MADISYN
Middle Name:
Last Name:BEHRENS
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 1:609 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:GOWRIE
Mailing Address - State:IA
Mailing Address - Zip Code:50543-7461
Mailing Address - Country:US
Mailing Address - Phone:515-370-5223
Mailing Address - Fax:
Practice Address - Street 1:1002 W LINCOLN WAY
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:IA
Practice Address - Zip Code:50129-1645
Practice Address - Country:US
Practice Address - Phone:515-386-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-26
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA124462104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker