Provider Demographics
NPI:1356932305
Name:DEGENHARDT, MADELINE
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:
Last Name:DEGENHARDT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11455 E 84TH CIR S
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:KS
Mailing Address - Zip Code:67037-7805
Mailing Address - Country:US
Mailing Address - Phone:316-706-4268
Mailing Address - Fax:
Practice Address - Street 1:2455 N WOODLAWN BLVD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67220-3996
Practice Address - Country:US
Practice Address - Phone:316-687-3741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-02
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist