Provider Demographics
NPI:1770818007
Name:MADLOCK, FELICIA R (MSW)
Entity Type:Individual
Prefix:MS
First Name:FELICIA
Middle Name:R
Last Name:MADLOCK
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 E 162ND ST # 109
Mailing Address - Street 2:
Mailing Address - City:SOUTH HOLLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60473-2258
Mailing Address - Country:US
Mailing Address - Phone:773-369-6545
Mailing Address - Fax:708-260-0466
Practice Address - Street 1:10336 S WESTERN AVE STE 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-2411
Practice Address - Country:US
Practice Address - Phone:773-369-6545
Practice Address - Fax:708-260-0466
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-05
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490134101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical