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NPI Code Detail

MEDICARE: KATHLEEN MADL LCSW

MEDICARE: KATHLEEN MADL LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker149.015638IL

General Provider Information

NPI Number : 1477985273
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHLEEN MADL LCSW
Provider Business Mailing Address
First Line : 4516 N PAULINA ST
Second Line : G
City : CHICAGO
State : IL
Zip : 60640-5322
Country : US
Telephone Number : 847-894-7239
Fax Number :
Provider Business Practice Location Address
First Line : 737 N MICHIGAN AVE STE 2130
Second Line :
City : CHICAGO
State : IL
Zip : 60611-6747
Country : US
Telephone Number : 847-894-7239
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/02/2013
Last Update Date : 06/01/2016

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Directions to “ KATHLEEN MADL LCSW” Practice Location

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