Provider Demographics
NPI:1780960369
Name:MCFADDEN, VERONICA (AAS)
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:
Last Name:MCFADDEN
Suffix:
Gender:F
Credentials:AAS
Other - Prefix:
Other - First Name:VERONICA
Other - Middle Name:
Other - Last Name:WELLMAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AAS
Mailing Address - Street 1:1702 JULIANNE DR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-1525
Mailing Address - Country:US
Mailing Address - Phone:773-559-6055
Mailing Address - Fax:
Practice Address - Street 1:1307 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-1139
Practice Address - Country:US
Practice Address - Phone:618-997-5336
Practice Address - Fax:618-993-2969
Is Sole Proprietor?:No
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator