Provider Demographics
NPI:1902488919
Name:LING, MADELINE ELIZABETH (MA, LPC)
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:ELIZABETH
Last Name:LING
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 E CAPITOL DR
Mailing Address - Street 2:
Mailing Address - City:SHOREWOOD
Mailing Address - State:WI
Mailing Address - Zip Code:53211-2136
Mailing Address - Country:US
Mailing Address - Phone:714-600-4110
Mailing Address - Fax:
Practice Address - Street 1:2510 E CAPITOL DR
Practice Address - Street 2:
Practice Address - City:SHOREWOOD
Practice Address - State:WI
Practice Address - Zip Code:53211-2136
Practice Address - Country:US
Practice Address - Phone:714-600-4110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8189-125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health