Provider Demographics
NPI:1154982379
Name:EISENHOUR, MADELYN (RBT)
Entity type:Individual
Prefix:
First Name:MADELYN
Middle Name:
Last Name:EISENHOUR
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 DEPAUW BLVD STE 3070
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-6135
Mailing Address - Country:US
Mailing Address - Phone:317-449-4833
Mailing Address - Fax:317-520-8200
Practice Address - Street 1:9260 MARKETPLACE DR
Practice Address - Street 2:
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-4478
Practice Address - Country:US
Practice Address - Phone:937-388-5110
Practice Address - Fax:317-520-8200
Is Sole Proprietor?:No
Enumeration Date:2019-06-27
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
OHSP.15014235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst