Provider Demographics
NPI:1629653175
Name:BREUNIG, MADISEN (MS CF-SLP)
Entity Type:Individual
Prefix:
First Name:MADISEN
Middle Name:
Last Name:BREUNIG
Suffix:
Gender:F
Credentials:MS CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 ROYAL HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62226-5798
Mailing Address - Country:US
Mailing Address - Phone:618-234-8200
Mailing Address - Fax:
Practice Address - Street 1:840 ROYAL HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226-5798
Practice Address - Country:US
Practice Address - Phone:618-234-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2491198235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist