Provider Demographics
NPI:1568136703
Name:HANLEY, MADELIENE ELIZABETH (CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:MADELIENE
Middle Name:ELIZABETH
Last Name:HANLEY
Suffix:
Gender:
Credentials:CCC-SLP
Other - Prefix:MS
Other - First Name:MADDIE
Other - Middle Name:
Other - Last Name:HANLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11215 N DITMAN AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64157-1161
Mailing Address - Country:US
Mailing Address - Phone:352-434-8799
Mailing Address - Fax:
Practice Address - Street 1:6535 CHESTER AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-2247
Practice Address - Country:US
Practice Address - Phone:352-434-8799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-02
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19132235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist