Provider Demographics
NPI:1609661925
Name:MACKENZIE, MADELINE EILEEN (NCSP, ILLINOIS PEL)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:EILEEN
Last Name:MACKENZIE
Suffix:
Gender:
Credentials:NCSP, ILLINOIS PEL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 W HUBBARD STREET
Mailing Address - Street 2:APT 3511
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654
Mailing Address - Country:US
Mailing Address - Phone:630-640-6318
Mailing Address - Fax:
Practice Address - Street 1:2701 CENTRAL RD
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-4134
Practice Address - Country:US
Practice Address - Phone:847-657-2111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2558541103TS0200X
IL68219103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool