Provider Demographics
NPI:1982712097
Name:WINTERS, MADELON JOHANNA (LISW)
Entity type:Individual
Prefix:MS
First Name:MADELON
Middle Name:JOHANNA
Last Name:WINTERS
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:MS
Other - First Name:LYNN
Other - Middle Name:
Other - Last Name:WINTERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LISW
Mailing Address - Street 1:715 E IDAHO
Mailing Address - Street 2:BLDG 2 SUITE E
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-4701
Mailing Address - Country:US
Mailing Address - Phone:575-556-9585
Mailing Address - Fax:575-556-9456
Practice Address - Street 1:715 E IDAHO
Practice Address - Street 2:BLDG 2 SUITE E
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-4701
Practice Address - Country:US
Practice Address - Phone:575-556-9585
Practice Address - Fax:575-556-9456
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI35431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM18677037Medicaid
NM18677037Medicaid