Healthcare Provider Details

I. General information

NPI: 1700447414
Provider Name (Legal Business Name): MADELEINE MANGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2019
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12003 DAVISBURG RD
DAVISBURG MI
48350-2635
US

IV. Provider business mailing address

6589 NORTHVIEW DR
CLARKSTON MI
48346-1529
US

V. Phone/Fax

Practice location:
  • Phone: 248-328-3500
  • Fax:
Mailing address:
  • Phone: 248-909-7471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number14471900
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: