Provider Demographics
NPI:1073340469
Name:KOOIMA, MADELYN RAE
Entity type:Individual
Prefix:
First Name:MADELYN
Middle Name:RAE
Last Name:KOOIMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1408 FELLAND ST
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:WI
Mailing Address - Zip Code:53589-1072
Mailing Address - Country:US
Mailing Address - Phone:608-354-3646
Mailing Address - Fax:
Practice Address - Street 1:1408 FELLAND ST
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:WI
Practice Address - Zip Code:53589-1072
Practice Address - Country:US
Practice Address - Phone:608-354-3646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist