Provider Demographics
NPI:1699873018
Name:MADRIGAL, JUANITA SAN (MA,LCPC,CSADC)
Entity type:Individual
Prefix:MS
First Name:JUANITA
Middle Name:SAN
Last Name:MADRIGAL
Suffix:
Gender:F
Credentials:MA,LCPC,CSADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6711 26TH ST
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-2502
Mailing Address - Country:US
Mailing Address - Phone:708-749-2481
Mailing Address - Fax:708-749-9206
Practice Address - Street 1:6711 26TH ST
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-2502
Practice Address - Country:US
Practice Address - Phone:708-749-2481
Practice Address - Fax:708-749-9206
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional