Healthcare Provider Details

I. General information

NPI: 1700801412
Provider Name (Legal Business Name): DEBORAH L MCFADDEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41810 VALHALLA TOWHNHOUSE RD UNIT 11
CABLE WI
54821-5401
US

IV. Provider business mailing address

PO BOX 212
CABLE WI
54821-0212
US

V. Phone/Fax

Practice location:
  • Phone: 630-333-3202
  • Fax:
Mailing address:
  • Phone: 630-333-3203
  • Fax: 315-217-2428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149007397
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: