Provider Demographics
NPI:1528836996
Name:RAU, MADELYN
Entity type:Individual
Prefix:
First Name:MADELYN
Middle Name:
Last Name:RAU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8400 PALMETTO COMMERCE PKWY UNIT 2707
Mailing Address - Street 2:
Mailing Address - City:LADSON
Mailing Address - State:SC
Mailing Address - Zip Code:29456-6825
Mailing Address - Country:US
Mailing Address - Phone:513-967-9057
Mailing Address - Fax:
Practice Address - Street 1:8400 PALMETTO COMMERCE PKWY UNIT 2707
Practice Address - Street 2:
Practice Address - City:LADSON
Practice Address - State:SC
Practice Address - Zip Code:29456-6825
Practice Address - Country:US
Practice Address - Phone:513-967-9057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-15
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician