Healthcare Provider Details

I. General information

NPI: 1336989532
Provider Name (Legal Business Name): MADISON ROSE RYCHTANEK LPC, ATR-P
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2024
Last Update Date: 05/28/2024
Certification Date: 05/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3115 N WILKE RD STE HIO
ARLINGTON HEIGHTS IL
60004-1400
US

IV. Provider business mailing address

1041 AUTUMN DR
ANTIOCH IL
60002-2413
US

V. Phone/Fax

Practice location:
  • Phone: 847-975-5598
  • Fax:
Mailing address:
  • Phone: 224-545-9411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number178.020049
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number23-508
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: