Provider Demographics
NPI:1306014691
Name:MADIGAN, MARY E (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:MADIGAN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 GREENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-1335
Mailing Address - Country:US
Mailing Address - Phone:240-997-6346
Mailing Address - Fax:
Practice Address - Street 1:712 GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-1335
Practice Address - Country:US
Practice Address - Phone:240-997-6346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-20
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY12137706235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist