Provider Demographics
NPI:1790322329
Name:PIFER, MADELINE RUTH (SLP)
Entity Type:Individual
Prefix:MS
First Name:MADELINE
Middle Name:RUTH
Last Name:PIFER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1691
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93406-1691
Mailing Address - Country:US
Mailing Address - Phone:805-768-4916
Mailing Address - Fax:
Practice Address - Street 1:345 S HALCYON RD
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-3817
Practice Address - Country:US
Practice Address - Phone:805-473-7663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-02
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA30547235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA30547OtherCALIFORNIA STATE SPEECH PATHOLOGIST LICENSE
14305472OtherAMERICAN SPEECH LANGUAGE HEARING ASSOCIATION