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General NPI Number Information
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NPI Number | 1659049054
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Entity Type | Individual
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Provider Name | MADDELYN LEIGH TONJES LSW
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Gender | Female
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Dates
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Enumeration Date | 08/31/2021
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Last Update Date | 09/20/2023
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Provider Practice Location Address
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Address Line | 1507 W LAWRENCE AVE
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City | CHICAGO
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State | IL
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Zip | 60640-4702
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Country | US
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Telephone | 773-569-1468
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Fax |
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Provider Business Mailing Address
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Address Line | 3000 N SHERIDAN RD APT 5B
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City | CHICAGO
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State | IL
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Zip | 60657-5536
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Country | US
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Telephone | 952-456-1306
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 150105386
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License Number State | IL
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