Provider Demographics
NPI:1386124477
Name:LAMBRECHT, MADISON ROSE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:ROSE
Last Name:LAMBRECHT
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:ALICE
Other - Last Name:ROSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9200 SHELBYVILLE RD STE 531
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-5132
Mailing Address - Country:US
Mailing Address - Phone:502-792-0236
Mailing Address - Fax:
Practice Address - Street 1:3901 CENTRAL PIKE STE 500
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-3431
Practice Address - Country:US
Practice Address - Phone:502-792-0236
Practice Address - Fax:502-792-0236
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-17
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
TN8380235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician