Provider Demographics
NPI:1265050074
Name:MADON, LAUREN ROBYN (MSW)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:ROBYN
Last Name:MADON
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 1:424 W MADISON ST
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:IL
Mailing Address - Zip Code:61350-2833
Mailing Address - Country:US
Mailing Address - Phone:815-433-3953
Mailing Address - Fax:815-433-3980
Practice Address - Street 1:424 W MADISON ST
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:IL
Practice Address - Zip Code:61350-2833
Practice Address - Country:US
Practice Address - Phone:815-433-3953
Practice Address - Fax:815-433-3980
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-08
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150102557101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL07012020OtherEMPLOYEE ID