Provider Demographics
NPI:1578165874
Name:ANKELE, MADALEINE (LMT)
Entity Type:Individual
Prefix:
First Name:MADALEINE
Middle Name:
Last Name:ANKELE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1752 WINDSOR RD STE 202
Mailing Address - Street 2:
Mailing Address - City:LOVES PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61111-4276
Mailing Address - Country:US
Mailing Address - Phone:815-977-3747
Mailing Address - Fax:
Practice Address - Street 1:1752 WINDSOR RD STE 202
Practice Address - Street 2:
Practice Address - City:LOVES PARK
Practice Address - State:IL
Practice Address - Zip Code:61111-4276
Practice Address - Country:US
Practice Address - Phone:815-977-3747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-11
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227-021667225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist