Provider Demographics
NPI:1396361697
Name:TROST, MADDIE
Entity Type:Individual
Prefix:
First Name:MADDIE
Middle Name:
Last Name:TROST
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 1:841 PLAINFIELD NAPERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-6466
Mailing Address - Country:US
Mailing Address - Phone:630-777-4841
Mailing Address - Fax:
Practice Address - Street 1:841 PLAINFIELD NAPERVILLE RD
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-6466
Practice Address - Country:US
Practice Address - Phone:630-777-4841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-23
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician