Provider Demographics
NPI:1659049054
Name:TONJES, MADDELYN LEIGH (LSW)
Entity Type:Individual
Prefix:
First Name:MADDELYN
Middle Name:LEIGH
Last Name:TONJES
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 N SHERIDAN RD APT 5B
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5536
Mailing Address - Country:US
Mailing Address - Phone:952-456-1306
Mailing Address - Fax:
Practice Address - Street 1:1507 W LAWRENCE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-4702
Practice Address - Country:US
Practice Address - Phone:773-569-1468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-31
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150105386104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker