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General NPI Number Information
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NPI Number | 1003164286
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Entity Type | Individual
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Provider Name | MARY MADSEN-HESKIN M.A.
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Gender | Female
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Dates
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Enumeration Date | 08/20/2012
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Last Update Date | 10/31/2018
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Provider Practice Location Address
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Address Line | 475 DUNHAM RD STE 2A
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City | SAINT CHARLES
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State | IL
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Zip | 60174-1498
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Country | US
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Telephone | 224-805-0600
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Fax | 331-422-2905
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Provider Business Mailing Address
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Address Line | 475 DUNHAM RD STE 2A
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City | SAINT CHARLES
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State | IL
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Zip | 60174-1498
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Country | US
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Telephone | 224-805-0600
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Fax | 331-422-2905
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 180004564
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 180004564
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180004564
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License Number State | IL
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