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General NPI Number Information
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NPI Number | 1609661925
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Entity Type | Individual
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Provider Name | MADELINE EILEEN MACKENZIE NCSP, ILLINOIS PEL
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Gender | Female
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Dates
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Enumeration Date | 04/09/2025
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Last Update Date | 04/16/2025
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Provider Practice Location Address
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Address Line | 2701 CENTRAL RD
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City | GLENVIEW
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State | IL
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Zip | 60025-4134
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Country | US
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Telephone | 847-657-2111
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Fax |
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Provider Business Mailing Address
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Address Line | 71 W HUBBARD STREET APT 3511
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City | CHICAGO
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State | IL
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Zip | 60654
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Country | US
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Telephone | 630-640-6318
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Fax |
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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 | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 2558541
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 68219
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License Number State | IL
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