Provider Demographics
NPI:1851198469
Name:THOMAS, MADELYN (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MADELYN
Middle Name:
Last Name:THOMAS
Suffix:
Gender:
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 1:144 N JEFFERSON ST UNIT 405
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-6123
Mailing Address - Country:US
Mailing Address - Phone:262-364-9049
Mailing Address - Fax:
Practice Address - Street 1:740 PILGRIM PKWY STE 100
Practice Address - Street 2:
Practice Address - City:ELM GROVE
Practice Address - State:WI
Practice Address - Zip Code:53122-2067
Practice Address - Country:US
Practice Address - Phone:262-364-9049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-01
Last Update Date:2025-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4757-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist