Provider Demographics
NPI:1649013566
Name:THOMAS, MADELAINE (SLP)
Entity type:Individual
Prefix:
First Name:MADELAINE
Middle Name:
Last Name:THOMAS
Suffix:
Gender:
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 BPW CLUB RD APT A9
Mailing Address - Street 2:
Mailing Address - City:CARRBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27510-2505
Mailing Address - Country:US
Mailing Address - Phone:563-676-0506
Mailing Address - Fax:
Practice Address - Street 1:110 TWO HILLS DR
Practice Address - Street 2:
Practice Address - City:CARRBORO
Practice Address - State:NC
Practice Address - Zip Code:27510-2675
Practice Address - Country:US
Practice Address - Phone:984-849-3597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-18
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30002970235Z00000X
NC30003761235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist