Provider Demographics
NPI:1093555492
Name:MACIEJEWSKI, MADISON PATRICE
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:PATRICE
Last Name:MACIEJEWSKI
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 1:6688 N 2075 EAST RD
Mailing Address - Street 2:
Mailing Address - City:DOWNS
Mailing Address - State:IL
Mailing Address - Zip Code:61736-7520
Mailing Address - Country:US
Mailing Address - Phone:309-825-9363
Mailing Address - Fax:
Practice Address - Street 1:100 TRI-STATE INTERNATIONAL DR
Practice Address - Street 2:SUITE 135
Practice Address - City:LINCOLNSHIRE
Practice Address - State:IL
Practice Address - Zip Code:60069
Practice Address - Country:US
Practice Address - Phone:847-607-1520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-31
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health