Provider Demographics
NPI:1003095027
Name:MADDEN, ALISSA LEIGH (LICSW)
Entity type:Individual
Prefix:
First Name:ALISSA
Middle Name:LEIGH
Last Name:MADDEN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 WEIR DR
Mailing Address - Street 2:SUITE 355
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-2272
Mailing Address - Country:US
Mailing Address - Phone:651-730-6151
Mailing Address - Fax:
Practice Address - Street 1:1811 WEIR DR
Practice Address - Street 2:SUITE 355
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-2272
Practice Address - Country:US
Practice Address - Phone:651-730-6151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN163341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical