Provider Demographics
NPI:1881255073
Name:BRCIC, MADELINE ELISE (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:ELISE
Last Name:BRCIC
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 1:130 CANTERBURY DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48813-1039
Mailing Address - Country:US
Mailing Address - Phone:810-287-9084
Mailing Address - Fax:
Practice Address - Street 1:530 BEECH ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:MI
Practice Address - Zip Code:48813-1016
Practice Address - Country:US
Practice Address - Phone:517-231-0396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-27
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101006328235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist