Healthcare Provider Details

I. General information

NPI: 1619805231
Provider Name (Legal Business Name): MADISON HOOVER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

917 SHERWOOD DR
LAKE BLUFF IL
60044-2224
US

IV. Provider business mailing address

646 IRIS CT
LAKE VILLA IL
60046-9028
US

V. Phone/Fax

Practice location:
  • Phone: 224-249-2669
  • Fax:
Mailing address:
  • Phone: 224-308-6289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: