Provider Demographics
NPI:1396476412
Name:PAHLS, MADISON S (SLP)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:S
Last Name:PAHLS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:S
Other - Last Name:MITTIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:1133 COLLEGE AVE STE E230
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-2818
Mailing Address - Country:US
Mailing Address - Phone:785-587-1825
Mailing Address - Fax:785-587-1828
Practice Address - Street 1:1133 COLLEGE AVE STE E230
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-2818
Practice Address - Country:US
Practice Address - Phone:785-587-1825
Practice Address - Fax:785-587-1828
Is Sole Proprietor?:No
Enumeration Date:2022-06-20
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS5283235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist