Healthcare Provider Details

I. General information

NPI: 1780767723
Provider Name (Legal Business Name): MAUDLIN & ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 03/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 W ROOSEVELT RD SUITE B-1
WHEATON IL
60187-5087
US

IV. Provider business mailing address

610 W ROOSEVELT RD SUITE B-1
WHEATON IL
60187-5087
US

V. Phone/Fax

Practice location:
  • Phone: 603-462-3999
  • Fax: 630-462-0911
Mailing address:
  • Phone: 603-462-3999
  • Fax: 630-462-0911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071-004470
License Number StateIL

VIII. Authorized Official

Name: DR. KAREN LEIGH MAUDLIN
Title or Position: MANAGER
Credential: PSY.D.
Phone: 630-462-3999