Provider Demographics
NPI:1821226069
Name:MARICHAL, MADELYN (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:MADELYN
Middle Name:
Last Name:MARICHAL
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18245 NW 68TH AVE
Mailing Address - Street 2:#302
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-3457
Mailing Address - Country:US
Mailing Address - Phone:305-815-2423
Mailing Address - Fax:
Practice Address - Street 1:18245 NW 68TH AVE
Practice Address - Street 2:#302
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-3457
Practice Address - Country:US
Practice Address - Phone:305-815-2423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-25
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA9385235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist