Provider Demographics
NPI:1972129906
Name:DOW, MADDISON MARIE
Entity Type:Individual
Prefix:
First Name:MADDISON
Middle Name:MARIE
Last Name:DOW
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:MADDISON
Other - Middle Name:MARIE
Other - Last Name:MADRIGAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:15 PARKWAY NORTH BLVD APT 245
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-2573
Mailing Address - Country:US
Mailing Address - Phone:630-744-9789
Mailing Address - Fax:
Practice Address - Street 1:3100 DUNDEE RD STE 101
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2462
Practice Address - Country:US
Practice Address - Phone:847-919-9096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-25
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.016039101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL90791OtherNON-MEDICARE
IL90834OtherNON-MEDICARE
IL90837OtherNON-MEDICARE
IL90839OtherNON-MEDICARE
IL90847OtherNON-MEDICARE
IL90846OtherNON-MEDICARE