Healthcare Provider Details

I. General information

NPI: 1003794785
Provider Name (Legal Business Name): MAGDELENE THEBAUD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2025
Last Update Date: 08/22/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 WILLIAMSBURG DR
ALGONQUIN IL
60102-2539
US

IV. Provider business mailing address

2620 WILLIAMSBURG DR
ALGONQUIN IL
60102-2539
US

V. Phone/Fax

Practice location:
  • Phone: 773-814-5636
  • Fax:
Mailing address:
  • Phone: 773-814-5636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number140.029365
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: