Magnolia Wellness Center

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

Legal business name

MAGNOLIA WELLNESS CENTER

Practice address

36936 N Corona Dr
Lake Villa, IL 60046-5800

Phone

(773) 294-7885

NPI assigned

Feb 3, 2023

Last updated

Feb 3, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Alexandra Colon, PSYD

Title

Owner

Phone

(773) 294-7885

Specialties & licenses 1

Addresses

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Tyler Donald Demers, PSY.D, LP

  • Clinical Psychologist
  • Elwood, IL
  • NPI 1386901247
  NPD (past)
• Natalia Kaczmarek, PSY.D.

  • Psychologist
  • Northbrook, IL
  • NPI 1215466032
  NPD (past)

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

{
    "created_epoch": "1675382400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675382400000",
    "number": "1740986421",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2724 W CHICAGO AVE APT 2F",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606225169",
            "telephone_number": "773-294-7885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36936 N CORONA DR",
            "city": "LAKE VILLA",
            "state": "IL",
            "postal_code": "600465800",
            "telephone_number": "773-294-7885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGNOLIA WELLNESS CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-03",
        "last_updated": "2023-02-03",
        "certification_date": "2023-02-03",
        "status": "A",
        "authorized_official_last_name": "COLON",
        "authorized_official_first_name": "ALEXANDRA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "773-294-7885",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Courtney Leonard, SLP
• Jessica Leigh Lipinski, LSW
• George Winston Lutz, PH.D.
• Anita Johanson Maddox, LCPC
• Susan R Magee, LCPC, CADC
• Martin Pediatric Physical Therapy, Inc.
• Joy Suzann Martin, DPT
• Viktoriia V Martin, LPC
• Semyon Maslovsky, MD
• Gabrielle Mazade, APRN, CNP

• Clinical Psychologist in Lake Villa, IL
• Providers in Lake Villa, IL by specialty
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2023; 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.