Provider Demographics
NPI:1679617864
Name:MADDI, KAREN LISA (PHD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:LISA
Last Name:MADDI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2235 W FLETCHER ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-6403
Mailing Address - Country:US
Mailing Address - Phone:773-248-8588
Mailing Address - Fax:
Practice Address - Street 1:11 S LA SALLE ST
Practice Address - Street 2:SUITE 2600
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60603-1203
Practice Address - Country:US
Practice Address - Phone:312-458-0873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL71004057103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001673361OtherBCBS PROVIDER