Basic Information
| Provider Information | |||||||||
| NPI: | 1548991938 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALBERS | ||||||||
| FirstName: | MADELYN | ||||||||
| MiddleName: | GRACE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 900 TECHNOLOGY WAY STE 320 | ||||||||
| Address2: | |||||||||
| City: | LIBERTYVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600485364 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476802715 | ||||||||
| FaxNumber: | 8476803852 | ||||||||
| Practice Location | |||||||||
| Address1: | 900 TECHNOLOGY WAY STE 320 | ||||||||
| Address2: | |||||||||
| City: | LIBERTYVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600485364 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476802715 | ||||||||
| FaxNumber: | 8476803852 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2022 | ||||||||
| LastUpdateDate: | 06/17/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 178017819 | IL | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 178017819 | 01 | IL | LICENSE | OTHER |