Provider Demographics
NPI:1811729122
Name:PHELPS, MADELINE (SLP)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:
Last Name:PHELPS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:MADELINE
Other - Middle Name:
Other - Last Name:FLAHERTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:868 TURTLE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-8980
Mailing Address - Country:US
Mailing Address - Phone:270-315-5538
Mailing Address - Fax:
Practice Address - Street 1:605 PARK PLAZA DR
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-5485
Practice Address - Country:US
Practice Address - Phone:270-478-4366
Practice Address - Fax:270-478-4367
Is Sole Proprietor?:No
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYSLP-293313235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist