Maddox, Anita Johanson

Maddox, Anita Johanson is an individual health care provider with primary practice located at 89 Cedar Ave , Lake Villa IL 60046-8411. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Professional, Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Developmental Therapist. Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Developmental Therapist is her primary health care specialty. Maddox, Anita Johanson can be contacted via phone (847) 265-7300.

Contact Information

Primary practice address
89 Cedar Ave Lake Villa IL 60046-8411
Phone: (847) 265-7300
Fax: (847) 265-7301
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Professional 101YP2500X 180004644 Illinois
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Developmental Therapist 222Q00000X AM47190798P Illinois

Profile Details

NPI number 1770623407
LBN Legal business name Maddox, Anita Johanson
Credentials LCPC
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 8th, 2007
Last updated Sep 21st, 2010 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1770623407 NPPES
Illinois Other 04932271 BLUE SHIELD
Illinois Other 710957905 BLUE SHIELD

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