Provider Demographics
NPI:1982828976
Name:THOMAS, MADELEINE DURHAM (MEDCCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MADELEINE
Middle Name:DURHAM
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MEDCCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4841 WOODFIELD DR
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46033-9424
Mailing Address - Country:US
Mailing Address - Phone:317-844-2168
Mailing Address - Fax:
Practice Address - Street 1:13250 HAZEL DELL PKWY STE 102
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46033-8527
Practice Address - Country:US
Practice Address - Phone:317-818-8166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22001947A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist