Basic Information
| Provider Information | |||||||||
| NPI: | 1487307765 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SQUIRES | ||||||||
| FirstName: | MADELINE | ||||||||
| MiddleName: | ANNE | ||||||||
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| Credential: | LICSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6725 4TH AVE S | ||||||||
| Address2: | |||||||||
| City: | RICHFIELD | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554232423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6502242536 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3400 W 66TH ST STE 400 | ||||||||
| Address2: | |||||||||
| City: | EDINA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554352134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6126726999 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/27/2022 | ||||||||
| LastUpdateDate: | 01/27/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 28606 | MN | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.