Provider Demographics
NPI:1215154042
Name:ROSOL, MAGDALENA D (MSED, LCPC)
Entity type:Individual
Prefix:
First Name:MAGDALENA
Middle Name:D
Last Name:ROSOL
Suffix:
Gender:F
Credentials:MSED, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 PARKWAY DR
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62629-9782
Mailing Address - Country:US
Mailing Address - Phone:618-203-6777
Mailing Address - Fax:
Practice Address - Street 1:137 PARKWAY DR
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:IL
Practice Address - Zip Code:62629-9782
Practice Address - Country:US
Practice Address - Phone:618-203-6777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180005712101Y00000X, 101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL180005712OtherLICENSE
IL28141OtherCADC
IL106477OtherHEALTH ALLIANCE