Provider Demographics
NPI:1982290623
Name:CORDOVA, MADISON K (LCSW)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:K
Last Name:CORDOVA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:
Other - Last Name:LANKHAAR-CORDOVA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:1650 S TOPAZ WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-4474
Mailing Address - Country:US
Mailing Address - Phone:208-605-7070
Mailing Address - Fax:208-898-3365
Practice Address - Street 1:847 PARKCENTRE WAY STE 7
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-1794
Practice Address - Country:US
Practice Address - Phone:208-229-6050
Practice Address - Fax:855-212-5682
Is Sole Proprietor?:No
Enumeration Date:2020-12-16
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
IDLCSW-446591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)