Healthcare Provider Details

I. General information

NPI: 1598699241
Provider Name (Legal Business Name): MADELYN GREEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

395 GUERNSEY LN
RED WING MN
55066-7415
US

IV. Provider business mailing address

640 N WABASHA
PLAINVIEW MN
55964-1263
US

V. Phone/Fax

Practice location:
  • Phone: 651-388-4441
  • Fax:
Mailing address:
  • Phone: 507-276-4349
  • Fax: 507-276-4349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: