Provider Demographics
NPI:1538851217
Name:MANDESE, MADELYN ROSE (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:MADELYN
Middle Name:ROSE
Last Name:MANDESE
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 1:1100 PLUM CRK PKWY UNIT 6204
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-4150
Mailing Address - Country:US
Mailing Address - Phone:407-844-6273
Mailing Address - Fax:
Practice Address - Street 1:815 S PERRY ST STE 200
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-3376
Practice Address - Country:US
Practice Address - Phone:720-398-8806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-22
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSLP.0000945235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist