=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568386951
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MADELYN BELVILLE SSP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/07/2026
-----------------------------------------------------
Last Update Date | 08/07/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 323 W WASHINGTON ST
-----------------------------------------------------
City | MACOMB
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61455-2118
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 309-833-4161
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2313 MAPLE AVE
-----------------------------------------------------
City | MACOMB
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61455-3275
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 217-491-7719
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TS0200X
-----------------------------------------------------
Taxonomy Name | School Psychologist
-----------------------------------------------------
License Number | 2697194
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------