Provider Demographics
NPI:1235225491
Name:CISSNA, MADELEINE (AUD)
Entity Type:Individual
Prefix:MS
First Name:MADELEINE
Middle Name:
Last Name:CISSNA
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11014 GLUECK LN
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-1618
Mailing Address - Country:US
Mailing Address - Phone:301-221-2208
Mailing Address - Fax:
Practice Address - Street 1:11014 GLUECK LN
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-1618
Practice Address - Country:US
Practice Address - Phone:301-221-2208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT005812231H00000X
MD00931231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist