Provider Demographics
NPI:1003084062
Name:CLOUSE, MAUDE (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MAUDE
Middle Name:
Last Name:CLOUSE
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 SE 33RD STREET
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-4157
Mailing Address - Country:US
Mailing Address - Phone:239-470-9772
Mailing Address - Fax:239-995-2924
Practice Address - Street 1:2328 HANCOCK BRIDGE PARKWAY
Practice Address - Street 2:SUITE # 112 B
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990
Practice Address - Country:US
Practice Address - Phone:239-573-2368
Practice Address - Fax:239-995-2924
Is Sole Proprietor?:No
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA9218235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist