Provider Demographics
NPI:1558978189
Name:MACH, DEBORAH A
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:A
Last Name:MACH
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 1:350 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60433-1150
Mailing Address - Country:US
Mailing Address - Phone:815-725-5188
Mailing Address - Fax:
Practice Address - Street 1:621 ROLLINGWOOD DR
Practice Address - Street 2:
Practice Address - City:SHOREWOOD
Practice Address - State:IL
Practice Address - Zip Code:60404-0665
Practice Address - Country:US
Practice Address - Phone:708-517-0320
Practice Address - Fax:815-725-7550
Is Sole Proprietor?:No
Enumeration Date:2020-09-28
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.015442101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional