Provider Demographics
NPI:1427832120
Name:BURKE, MADISON ROSE (MS CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:MADISON
Middle Name:ROSE
Last Name:BURKE
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11201 BROOK GREEN LN
Mailing Address - Street 2:
Mailing Address - City:HASLET
Mailing Address - State:TX
Mailing Address - Zip Code:76052-4122
Mailing Address - Country:US
Mailing Address - Phone:214-235-5978
Mailing Address - Fax:
Practice Address - Street 1:8850 ELBE TRL
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76118-7408
Practice Address - Country:US
Practice Address - Phone:817-399-3434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-23
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120607235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist