Provider Demographics
NPI:1659060366
Name:MARINO, MADELINE (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:
Last Name:MARINO
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:MADELINE
Other - Middle Name:
Other - Last Name:NARDUCCI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8101 BOAT CLUB RD STE 240-319
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76179-3630
Mailing Address - Country:US
Mailing Address - Phone:682-498-3928
Mailing Address - Fax:214-935-2457
Practice Address - Street 1:201 BILLINGS ST STE 490
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76010-5401
Practice Address - Country:US
Practice Address - Phone:469-587-9397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-08
Last Update Date:2025-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA113125235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist