Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | 180004564 | IL |
N | 101YM0800X | Mental Health Counselor | 180004564 | IL |
Y | 101YP2500X | Professional Counselor | 180004564 | IL |
NPI | 1003164286 |
---|---|
Provider Name | Mary Madsen-Heskin |
First Address | Saint Charles, IL 60174-1498 |
Second Address | Saint Charles, IL 60174-1498 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2012 |
Last Update Date | 31/10/2018 |