Provider Demographics
NPI:1326434168
Name:LEE MADDEN LICENSED CLINICAL PSYCHOLOGIST
Entity Type:Organization
Organization Name:LEE MADDEN LICENSED CLINICAL PSYCHOLOGIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MADDEN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:708-383-0729
Mailing Address - Street 1:6601 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-1005
Mailing Address - Country:US
Mailing Address - Phone:708-383-0729
Mailing Address - Fax:
Practice Address - Street 1:6601 NORTH AVE
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-1005
Practice Address - Country:US
Practice Address - Phone:708-383-0729
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-08
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071006523103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL06937Medicare PIN