Provider Demographics
NPI:1023536943
Name:MADRIGAL CONSULTING
Entity Type:Organization
Organization Name:MADRIGAL CONSULTING
Other - Org Name:MADRIGAL CONSULTING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CESAR
Authorized Official - Middle Name:
Authorized Official - Last Name:MADRIGAL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:630-749-2279
Mailing Address - Street 1:450 E 22ND ST STE 150
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-6118
Mailing Address - Country:US
Mailing Address - Phone:630-749-2279
Mailing Address - Fax:
Practice Address - Street 1:450 E 22ND ST STE 150
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-6118
Practice Address - Country:US
Practice Address - Phone:630-749-2279
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL14900488981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL341566428001Medicaid