Provider Demographics
NPI:1740587054
Name:MADDEN, JANE ELLEN (MS, CCC)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:ELLEN
Last Name:MADDEN
Suffix:
Gender:F
Credentials:MS, CCC
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:ELLEN
Other - Last Name:MCCORMACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:36 HERRICK CIR
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03076-2645
Mailing Address - Country:US
Mailing Address - Phone:603-898-0516
Mailing Address - Fax:
Practice Address - Street 1:36 HERRICK CIR
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:NH
Practice Address - Zip Code:03076-2645
Practice Address - Country:US
Practice Address - Phone:603-898-0516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-23
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0319235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist