Provider Demographics
NPI:1700367133
Name:MOLINO, MADISON RAIN (CSWI)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:RAIN
Last Name:MOLINO
Suffix:
Gender:F
Credentials:CSWI
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:RAIN
Other - Last Name:MOLINO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CSWI
Mailing Address - Street 1:8029 S 700 E
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-0555
Mailing Address - Country:US
Mailing Address - Phone:801-633-7314
Mailing Address - Fax:
Practice Address - Street 1:8029 S 700 E
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-0555
Practice Address - Country:US
Practice Address - Phone:385-557-2183
Practice Address - Fax:385-557-2189
Is Sole Proprietor?:No
Enumeration Date:2018-08-23
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11939680-35061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical