Provider Demographics
NPI:1811603715
Name:COLWELL, MADDISON ELIZABETH (BA)
Entity type:Individual
Prefix:
First Name:MADDISON
Middle Name:ELIZABETH
Last Name:COLWELL
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 W RAY FINE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROLAND
Mailing Address - State:OK
Mailing Address - Zip Code:74954
Mailing Address - Country:US
Mailing Address - Phone:918-427-3344
Mailing Address - Fax:
Practice Address - Street 1:26241 US HIGHWAY 59
Practice Address - Street 2:
Practice Address - City:SHADY POINT
Practice Address - State:OK
Practice Address - Zip Code:74956-7495
Practice Address - Country:US
Practice Address - Phone:918-385-2772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator