Maple Street Clinic LTD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

036072942 Issued in IL

Legal business name

MAPLE STREET CLINIC LTD

Practice address

1401 15TH St
Lawrenceville, IL 62439-2223

Phone

(618) 839-4618

Fax

(618) 943-1700

NPI assigned

Jul 25, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Linda E Hungerford, MD

Title

President

Phone

(618) 839-1561

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1395187200000",
    "number": "1245252204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 15TH ST",
            "city": "LAWRENCEVILLE",
            "state": "IL",
            "postal_code": "624392223",
            "telephone_number": "618-839-4618",
            "fax_number": "618-943-1700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 15TH ST",
            "city": "LAWRENCEVILLE",
            "state": "IL",
            "postal_code": "624392223",
            "telephone_number": "618-839-4618",
            "fax_number": "618-943-1700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAPLE STREET CLINIC LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-25",
        "last_updated": "2014-03-19",
        "status": "A",
        "authorized_official_last_name": "HUNGERFORD",
        "authorized_official_first_name": "LINDA",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "618-839-1561",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IL",
            "license": "036072942",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036072942",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Audrey Diane Linder, PHARMD
• Katelynn Littlejohn
• Cynthia Lockley
• Zach Manley
• Christan Manning
• Amy Jo Marley, RN, BSN
• Emma Jane Marsh
• Jessica Rae Marshall, M.S. CCC-SLP
• Ashley Dawn McAdow, BSW
• Tanna Lynn McCullough, FNP

• Psychiatry Physician in Lawrenceville, IL
• Providers in Lawrenceville, IL by specialty
• Psychiatry Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.