Provider Demographics
NPI:1982824710
Name:MADETZKE, CORA (MS CCC SLP)
Entity Type:Individual
Prefix:
First Name:CORA
Middle Name:
Last Name:MADETZKE
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 1:618 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76501-3249
Mailing Address - Country:US
Mailing Address - Phone:254-773-6787
Mailing Address - Fax:254-770-0516
Practice Address - Street 1:1007 S ANN BLVD
Practice Address - Street 2:
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548-1254
Practice Address - Country:US
Practice Address - Phone:254-699-2090
Practice Address - Fax:254-699-7293
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101162235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist