Provider Demographics
NPI:1922821057
Name:BOENDER, MADISON SUSANNE (T-LMHC)
Entity type:Individual
Prefix:MRS
First Name:MADISON
Middle Name:SUSANNE
Last Name:BOENDER
Suffix:
Gender:F
Credentials:T-LMHC
Other - Prefix:MISS
Other - First Name:MADISON
Other - Middle Name:SUSANNE
Other - Last Name:THINGSTAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1010 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:50138-1950
Mailing Address - Country:US
Mailing Address - Phone:641-204-1911
Mailing Address - Fax:
Practice Address - Street 1:204 E ROBINSON ST
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:IA
Practice Address - Zip Code:50138-2235
Practice Address - Country:US
Practice Address - Phone:641-205-8501
Practice Address - Fax:641-205-8059
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA128671101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health