Provider Demographics
NPI:1093571432
Name:MADRIO, HENDESSA AMEDO
Entity Type:Individual
Prefix:
First Name:HENDESSA
Middle Name:AMEDO
Last Name:MADRIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 GLENDALE RD
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-4542
Mailing Address - Country:US
Mailing Address - Phone:224-715-6382
Mailing Address - Fax:
Practice Address - Street 1:500 GLENDALE RD
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-4542
Practice Address - Country:US
Practice Address - Phone:224-715-6382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-23
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178019894101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional