Provider Demographics
NPI:1730814500
Name:MANN, MADILYN SARAH
Entity type:Individual
Prefix:
First Name:MADILYN
Middle Name:SARAH
Last Name:MANN
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 1:850 PACIFIC ST APT 54
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-7366
Mailing Address - Country:US
Mailing Address - Phone:317-989-6296
Mailing Address - Fax:
Practice Address - Street 1:850 PACIFIC ST APT 54
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-7366
Practice Address - Country:US
Practice Address - Phone:317-989-6296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-18
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty