Provider Demographics
NPI:1467464792
Name:MADVIG, BRIAN T (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:T
Last Name:MADVIG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 S NAPERVILLE RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-8155
Mailing Address - Country:US
Mailing Address - Phone:630-462-7005
Mailing Address - Fax:630-462-7006
Practice Address - Street 1:1725 S NAPERVILLE RD
Practice Address - Street 2:SUITE 207
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-8155
Practice Address - Country:US
Practice Address - Phone:630-462-7005
Practice Address - Fax:630-462-7006
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical