Healthcare Provider Details

I. General information

NPI: 1134838261
Provider Name (Legal Business Name): MADELINE MCDONNELL LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2022
Last Update Date: 11/17/2022
Certification Date: 11/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1142 W MADISON ST STE 302
CHICAGO IL
60607-2191
US

IV. Provider business mailing address

165 N CANAL ST APT 506
CHICAGO IL
60606-1504
US

V. Phone/Fax

Practice location:
  • Phone: 312-324-4502
  • Fax:
Mailing address:
  • Phone: 612-408-5601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number178.018563
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.018563
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178.018563
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: