Healthcare Provider Details

I. General information

NPI: 1275496341
Provider Name (Legal Business Name): CAROLINE ROSE MADAFFER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2025
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28700 EUCLID AVE
WICKLIFFE OH
44092-2527
US

IV. Provider business mailing address

4385 EASTWICKE BLVD
STOW OH
44224-5143
US

V. Phone/Fax

Practice location:
  • Phone: 440-943-7607
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberCOND.20253188-SP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: