Provider Demographics
NPI:1962290783
Name:LALIM, MADISON TAYLOR (MSW, LGSW, LADC)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:TAYLOR
Last Name:LALIM
Suffix:
Gender:
Credentials:MSW, LGSW, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 12TH ST N STE 201
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-2253
Mailing Address - Country:US
Mailing Address - Phone:320-229-3760
Mailing Address - Fax:
Practice Address - Street 1:3701 12TH ST N STE 201
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-2253
Practice Address - Country:US
Practice Address - Phone:320-229-3760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN34476104100000X
MN306833101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker