Provider Demographics
NPI:1780767723
Name:MAUDLIN & ASSOCIATES LLC
Entity type:Organization
Organization Name:MAUDLIN & ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:MAUDLIN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:630-462-3999
Mailing Address - Street 1:610 W ROOSEVELT RD
Mailing Address - Street 2:SUITE B-1
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-5087
Mailing Address - Country:US
Mailing Address - Phone:603-462-3999
Mailing Address - Fax:630-462-0911
Practice Address - Street 1:610 W ROOSEVELT RD
Practice Address - Street 2:SUITE B-1
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-5087
Practice Address - Country:US
Practice Address - Phone:603-462-3999
Practice Address - Fax:630-462-0911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-004470103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL227-3064OtherBC BS PROVIDER NUMBER