Healthcare Provider Details

I. General information

NPI: 1326558776
Provider Name (Legal Business Name): MADELYN SMITH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2017
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10441 CIRCLE DR APT 32C
OAK LAWN IL
60453-6412
US

IV. Provider business mailing address

10441 CIRCLE DR APT 32C
OAK LAWN IL
60453-6412
US

V. Phone/Fax

Practice location:
  • Phone: 708-822-9976
  • Fax: 708-822-9976
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: