Provider Demographics
NPI:1093354607
Name:MADAJ, KELSEY (LMFT)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:MADAJ
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 E IRVING PARK RD STE 205
Mailing Address - Street 2:
Mailing Address - City:ROSELLE
Mailing Address - State:IL
Mailing Address - Zip Code:60172-2357
Mailing Address - Country:US
Mailing Address - Phone:847-212-0494
Mailing Address - Fax:
Practice Address - Street 1:701 E IRVING PARK RD STE 205
Practice Address - Street 2:
Practice Address - City:ROSELLE
Practice Address - State:IL
Practice Address - Zip Code:60172-2357
Practice Address - Country:US
Practice Address - Phone:847-212-0494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-30
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166.001241106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist