Provider Demographics
NPI:1447529813
Name:KENT, MADIGAN (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:MADIGAN
Middle Name:
Last Name:KENT
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2334 W LAWRENCE AVE STE 218
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-1031
Mailing Address - Country:US
Mailing Address - Phone:312-465-3968
Mailing Address - Fax:
Practice Address - Street 1:2334 W LAWRENCE AVE STE 218
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-1031
Practice Address - Country:US
Practice Address - Phone:312-465-3968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-14
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490149841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical