Provider Demographics
NPI:1154089985
Name:INCE, MADELINE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:
Last Name:INCE
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 1:3800 PARK AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-2514
Mailing Address - Country:US
Mailing Address - Phone:314-678-6648
Mailing Address - Fax:314-268-4028
Practice Address - Street 1:3800 PARK AVE FL 2
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-2514
Practice Address - Country:US
Practice Address - Phone:314-678-6648
Practice Address - Fax:314-268-4028
Is Sole Proprietor?:No
Enumeration Date:2021-11-29
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019018004235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist