Provider Demographics
NPI:1164897203
Name:MADSEN, JOAN (LPC)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:MADSEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 613
Mailing Address - Street 2:
Mailing Address - City:CHANNAHON
Mailing Address - State:IL
Mailing Address - Zip Code:60410-0613
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:825 GREEN BAY RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-2597
Practice Address - Country:US
Practice Address - Phone:847-251-6630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-01
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178010528101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health