Provider Demographics
NPI:1306496898
Name:LINK, MADDIE ROSEMARY (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MADDIE
Middle Name:ROSEMARY
Last Name:LINK
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:MADDIE
Other - Middle Name:ROSEMARY
Other - Last Name:HUSMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1204 SE ROSEHILL DR
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64081-2765
Mailing Address - Country:US
Mailing Address - Phone:605-660-8414
Mailing Address - Fax:
Practice Address - Street 1:14500 E 42ND ST S STE 220
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-4700
Practice Address - Country:US
Practice Address - Phone:816-478-7800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-16
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019001959235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist