Provider Demographics
NPI:1760007223
Name:KYLE, MADISON (MSW, LGSW)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:KYLE
Suffix:
Gender:F
Credentials:MSW, LGSW
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:
Other - Last Name:BURNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 33
Mailing Address - Street 2:
Mailing Address - City:LARCHWOOD
Mailing Address - State:IA
Mailing Address - Zip Code:51241-0033
Mailing Address - Country:US
Mailing Address - Phone:712-209-3897
Mailing Address - Fax:
Practice Address - Street 1:317 N HERITAGE AVE
Practice Address - Street 2:
Practice Address - City:TEA
Practice Address - State:SD
Practice Address - Zip Code:57064-2539
Practice Address - Country:US
Practice Address - Phone:605-494-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-10
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN28922104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker