Healthcare Provider Details

I. General information

NPI: 1790656601
Provider Name (Legal Business Name): MADELINE COLBERT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2025
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 S PROMONTORY DR
CHICAGO IL
60649-1002
US

IV. Provider business mailing address

2802 W ALTGELD ST APT 2
CHICAGO IL
60647-5720
US

V. Phone/Fax

Practice location:
  • Phone: 773-363-6700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.029671
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: