Provider Demographics
NPI:1669216198
Name:THOMAS, MADELINE ROTUNDO
Entity type:Individual
Prefix:MRS
First Name:MADELINE
Middle Name:ROTUNDO
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:MADELINE
Other - Middle Name:FRANCESCA
Other - Last Name:ROTUNDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5615 TAYLORCREST DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-4282
Mailing Address - Country:US
Mailing Address - Phone:260-445-5996
Mailing Address - Fax:
Practice Address - Street 1:2000 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:LAKEWAY
Practice Address - State:TX
Practice Address - Zip Code:78734-4200
Practice Address - Country:US
Practice Address - Phone:512-759-6438
Practice Address - Fax:737-237-7092
Is Sole Proprietor?:No
Enumeration Date:2024-06-20
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX122487235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist