Provider Demographics
NPI:1740435825
Name:TIELL, MADELINE M (MA CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MADELINE
Middle Name:M
Last Name:TIELL
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 NANCY DR
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-5205
Mailing Address - Country:US
Mailing Address - Phone:845-634-4180
Mailing Address - Fax:
Practice Address - Street 1:5 NANCY DR
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-5205
Practice Address - Country:US
Practice Address - Phone:845-634-4180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-17
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012375-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist