Provider Demographics
NPI:1629832803
Name:DUVERNOIS, MADELYN KATE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MADELYN
Middle Name:KATE
Last Name:DUVERNOIS
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 1:603 DILEY RD
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-9939
Mailing Address - Country:US
Mailing Address - Phone:614-751-6413
Mailing Address - Fax:
Practice Address - Street 1:603 DILEY RD
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-9939
Practice Address - Country:US
Practice Address - Phone:614-751-6413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.15313235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist