Provider Demographics
NPI:1326172073
Name:MAUDLIN, KAREN LEIGH (PSYD, CPPC)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:LEIGH
Last Name:MAUDLIN
Suffix:
Gender:F
Credentials:PSYD, CPPC
Other - Prefix:DR
Other - First Name:KAREN
Other - Middle Name:LEIGH
Other - Last Name:MAUDLIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD, CPPC
Mailing Address - Street 1:610 W ROOSEVELT RD STE B1
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-2303
Mailing Address - Country:US
Mailing Address - Phone:630-462-3999
Mailing Address - Fax:
Practice Address - Street 1:610 W ROOSEVELT RD STE B1
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-2303
Practice Address - Country:US
Practice Address - Phone:630-462-3999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL227-3064OtherBC/BS PROVIDER