Provider Demographics
NPI:1922159078
Name:MADLER, KENNETH O (MA, CCC-A)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:O
Last Name:MADLER
Suffix:
Gender:M
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:IN
Mailing Address - Zip Code:47394-1822
Mailing Address - Country:US
Mailing Address - Phone:765-584-4327
Mailing Address - Fax:765-584-3677
Practice Address - Street 1:115 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:IN
Practice Address - Zip Code:47394-1822
Practice Address - Country:US
Practice Address - Phone:765-584-4327
Practice Address - Fax:765-584-3677
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23002191A237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000294346OtherANTHEM BCBS PROV NUMBER
IN200443140Medicaid
IN200443140Medicaid