ANITA JOHANSON MADDOX (NPI# 1770623407) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1770623407 |
| Entity Type | Individual |
| Full Name | ANITA JOHANSON MADDOX |
| Credential | LCPC |
| Practice Address |
89 Cedar Ave Lake Villa IL 60046-8411 |
| Mailing Address |
Po Box 764 Lake Villa IL 60046-0764 |
| Practice Telephone | 8472657300 |
| Practice Fax Number | 8472657301 |
| Mailing Telephone | 8472657300 |
| Mailing Fax Number | 8472657301 |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2010-09-21 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101YP2500X |
Counselor Specialization: Professional |
180004644 | IL | Behavioral Health & Social Service Providers |
| Y | 222Q00000X | Developmental Therapist | AM47190798P | IL | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | FEIN | 710957905 | 01 |
| IL | BLUE SHIELD | 04932271 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730736745 | Anita Gurley Maddox | Technician | 2723 Carver Rd, Griffin, GA 30224-7300 | 2019-08-23 |
| Street Address |
89 CEDAR AVE |
| City | LAKE VILLA |
| State | IL |
| Zip Code | 60046-8411 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710047964 | The Therapy Tree D.b.a. Birth To Three & Beyond Pediatric Therapies | Counselor | 89 Cedar Ave, Lake Villa, IL 60046-8411 | 2006-12-11 |
| 1093315905 | Ashley Perini | Counselor | 89 Cedar Ave, Lake Villa, IL 60046-8411 | 2020-10-29 |
| 1922625748 | Lisa Werner | Occupational Therapist | 89 Cedar Ave, Lake Villa, IL 60046-8411 | 2020-06-26 |
| 1689216079 | Michael Smith | Social Worker | 89 Cedar Ave, Lake Villa, IL 60046-8411 | 2019-10-17 |
| 1306400064 | Leah Baker | Speech-Language Pathologist | 89 Cedar Ave, Lake Villa, IL 60046-8411 | 2019-04-29 |
| 1548728165 | Jessica Werbie | Occupational Therapist | 89 Cedar Ave, Lake Villa, IL 60046-8411 | 2019-03-04 |
| 1033684006 | Chelsea Gahgan | Speech-Language Pathologist | 89 Cedar Ave, Lake Villa, IL 60046-8411 | 2018-10-05 |
| 1598245797 | Linnae Rutkowski | Counselor | 89 Cedar Ave, Lake Villa, IL 60046-8411 | 2018-08-16 |
| 1073017455 | Kathie Kennelly | Speech-Language Pathologist | 89 Cedar Ave, Lake Villa, IL 60046-8411 | 2018-03-21 |
| 1811425390 | Mary Elizabeth Hackel | Physical Therapist | 89 Cedar Ave, Lake Villa, IL 60046-8411 | 2017-05-30 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962021287 | Kathryn Anne Harper | Physical Therapist | 7900 Rollins Road, Lake Villa, ID 60046 | 2020-04-16 |
| 1508346263 | Milennium Medical Ltd | Nurse Practitioner | 2866 Falling Waters, Lindenhurst, IL 60046 | 2018-08-21 |
| 1497264121 | Gail Truger | Speech-Language Pathologist | 24750 W. Dering Lane, Lake Villa, IL 60046 | 2017-09-26 |
| 1104345669 | Tobias V Schirmer | Speech-Language Pathologist | Palombi Middle School, 133 South Mckinley, Lake Villa, IL 60046 | 2017-09-15 |
| 1699163410 | Daniel Aron Goldberg | Psychologist | 600 West Grand Avenue, Lake Villa, IL 60046 | 2014-12-31 |
| 1962838946 | Kendall Barber | Physical Therapist | 50 S Milwaukee Ave Ste 201, Lake Villa, IL 60046 | 2013-09-23 |
| 1790045284 | Illinois Bone and Joint Institute LLC | Orthopaedic Surgery | 1025 Red Oak Lane, Suite 100, Lindenhurst, IL 60046 | 2012-05-18 |
| 1548534977 | Daniela Cvetkova | Counselor | 3021 Falling Waters, Lindenhurst, IL 60046 | 2012-03-02 |
| 1225310568 | Dimitrios George Tsakos | Pharmacist | 399 South Route 45, Lindenhurst, IL 60046 | 2011-09-13 |
| 1285933085 | Abigail Jean Bradley | Developmental Therapist | 87 Bridlepath Drive, Lindenhurst, IL 60046 | 2011-03-18 |
| Find all providers in zip 60046 | ||||
| Taxonomy Code | 222Q00000X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Developmental Therapist |
| A Developmental Therapist is a person qualified by completion of an approved program in Developmental Therapy and where applicable credentialed by the state and practicing within the scope of the credential, or credentialed by completion of education experiences as approved by the state and practicing within the scope of that credential or, where state credentialing does not exist, certified by the Board of the Developmental Therapy Association. A developmental therapist evaluates children's global development in order to identify areas of developmental delay whether arising from physiological, neurological, or environmental factors, or a combination of factors; and designs, implements, and modifies therapeutic interventions for the child and the family to promote the child's acquisition of skills in a variety of developmental areas, including cognitive processes and social interaction in order to maximize functional independence and developmental homeostasis, and improve the quality of life at home and in the community; and provides consultation for the parents and other professionals working with the family on global development. |
| Notes: Source: The Illinois Developmental Therapists Association [1/1/2007: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699304899 | Chase Andrew Thomas | Developmental Therapist | 724 Petite Lake Rd, Lake Villa, IL 60046-5240 | 2020-04-08 |
| 1760682876 | Deana Lynn Jaros | Developmental Therapist | 36880 N Deer Trail Dr, Lake Villa, IL 60046-6731 | 2007-07-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003413568 | Amy Rohan | Developmental Therapist | 17545 Mulberry Ave, Tinley Park, IL 60487-6163 | 2020-10-07 |
| 1992302954 | Vannetta C Thompson | Developmental Therapist | 2247 Gunderson Ave Apt 2, Berwyn, IL 60402-5147 | 2020-10-02 |
| 1477150506 | Quanita Crawford | Developmental Therapist | 3734 W Cortland St Apt 303, Chicago, IL 60647-7565 | 2020-10-01 |
| 1740897412 | Angela Perry | Developmental Therapist | 521 Eden Park Dr, Rantoul, IL 61866-1507 | 2020-09-28 |
| 1235746975 | Dominique Scott | Developmental Therapist | 5342 S Wells St, Chicago, IL 60609-6219 | 2020-09-27 |
| 1003429820 | Adrienne C Latronica | Developmental Therapist | 9865 Cordoba Ct Apt 2b, Orland Park, IL 60462-3190 | 2020-08-31 |
| 1669083424 | Lindsay Miner | Developmental Therapist | 2272 W Leland Ave # 1e, Chicago, IL 60625-2006 | 2020-08-13 |
| 1851901672 | Gretchen Susanne Biggerstaff | Developmental Therapist | 1706 S Hancock St, Mc Leansboro, IL 62859-1996 | 2020-08-06 |
| 1205446549 | Rene Yvonne Green | Developmental Therapist | 14425 E Blue Ridge Dr, Effingham, IL 62401-7168 | 2020-08-02 |
| 1306455357 | Noel Elizabeth Ryall | Developmental Therapist | 9123 Baldwin Dr, Machesney Park, IL 61115-1715 | 2020-07-27 |
| Find all providers with the same taxonomy | ||||
| City | LAKE VILLA |
| Zip Code | 60046 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.