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Individual
MRS. MADELEINE PETHAN
Active
Individual
MRS. MADELEINE PETHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.A., CCC-SLP
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
12104
NC
235Z00000X
Speech-Language Pathologist
PCET001789
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1053667089
—
NC
01
—
1260932
WELLCARE
SC
01
—
19KQ3
BCBSNC
NC
01
—
4808956
AETNA
—
05
—
SAN138
—
SC
Enumeration date
07/27/2012
Last updated
06/15/2017
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