Provider Demographics
NPI:1285707877
Name:MATTKE, MARALINE PATRICIA (MSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:MARALINE
Middle Name:PATRICIA
Last Name:MATTKE
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:MRS
Other - First Name:MARALINE
Other - Middle Name:PATRICIA
Other - Last Name:MATTKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:250 WATER STONE CIR
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60431-8313
Mailing Address - Country:US
Mailing Address - Phone:815-740-4104
Mailing Address - Fax:815-740-4107
Practice Address - Street 1:250 WATER STONE CIR
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60431-8313
Practice Address - Country:US
Practice Address - Phone:815-740-4104
Practice Address - Fax:815-740-4107
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical