Provider Demographics
NPI:1689225237
Name:MADDEN, REBECCA LYNN
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:LYNN
Last Name:MADDEN
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 1:6331 VV RD
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE DU ROCHER
Mailing Address - State:IL
Mailing Address - Zip Code:62277-1411
Mailing Address - Country:US
Mailing Address - Phone:618-304-3520
Mailing Address - Fax:
Practice Address - Street 1:6331 VV RD
Practice Address - Street 2:
Practice Address - City:PRAIRIE DU ROCHER
Practice Address - State:IL
Practice Address - Zip Code:62277-1411
Practice Address - Country:US
Practice Address - Phone:618-304-3520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-25
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILRM99190620P222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist