Provider Demographics
NPI:1518595305
Name:MALABANAN, MADELINE ANNE (LPC)
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:ANNE
Last Name:MALABANAN
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 1:5901 ORANGE LN
Mailing Address - Street 2:
Mailing Address - City:OAK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60452-2027
Mailing Address - Country:US
Mailing Address - Phone:708-833-0752
Mailing Address - Fax:
Practice Address - Street 1:2625 BUTTERFIELD RD STE 101N
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-3405
Practice Address - Country:US
Practice Address - Phone:630-586-0900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-29
Last Update Date:2020-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178011455101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional