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General NPI Number Information
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NPI Number | 1487146874
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Entity Type | Individual
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Provider Name | MADELINE ELAINE BRUNGARDT
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Gender | Female
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Dates
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Enumeration Date | 06/01/2018
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 4500 FOREST PARK AVE FL 5
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City | SAINT LOUIS
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State | MO
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Zip | 63108-2114
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Country | US
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Telephone | 314-362-7509
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Fax | 888-452-4025
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Provider Business Mailing Address
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Address Line | PO BOX 7412011
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City | CHICAGO
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State | IL
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Zip | 60674-2011
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Country | US
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Telephone | 314-362-7509
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Fax | 314-362-7522
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 146028751
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 2025044991
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 118215
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License Number State | TX
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