Provider Demographics
NPI:1295486702
Name:KOCSE, MADISON (CCC-SLP)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:KOCSE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 10TH ST S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-3331
Mailing Address - Country:US
Mailing Address - Phone:610-217-7525
Mailing Address - Fax:
Practice Address - Street 1:6817 SOUTHPOINT PKWY STE 1602
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-6298
Practice Address - Country:US
Practice Address - Phone:904-945-7556
Practice Address - Fax:904-379-0113
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-17
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA20256235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL114496700Medicaid