MEDICARE: MADISON REILLY

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
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1881588226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADISON REILLY

Provider Business Mailing Address
First Line	:	1760 N CLYBOURN AVE APT 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-5569
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1760 N CLYBOURN AVE APT 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-5569
Country	:	US
Telephone Number	:	203-450-7516
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2025
Last Update Date	:	06/09/2025

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Directions to “ MADISON REILLY ” Practice Location

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