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NPI Code Detail

MEDICARE: JENNIFER LEE MADELEY LCSW

MEDICARE:   JENNIFER LEE MADELEY  LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker149017258IL

General Provider Information

NPI Number : 1417738881
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER LEE MADELEY LCSW
Provider Business Mailing Address
First Line : 1500 W KENNEDY RD
Second Line :
City : LAKE FOREST
State : IL
Zip : 60045-1099
Country : US
Telephone Number : 847-812-9797
Fax Number :
Provider Business Practice Location Address
First Line : 1500 W KENNEDY RD
Second Line :
City : LAKE FOREST
State : IL
Zip : 60045-1099
Country : US
Telephone Number : 847-812-9797
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/11/2023
Last Update Date : 10/11/2023

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Directions to “ JENNIFER LEE MADELEY LCSW” Practice Location

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