| Doctor Name: | MRS. MADELEINE PETHAN |
| NPI Number: | 1053667089 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.A. SLP |
| License Number: | PCET001789 |
| Business Practice Address: | 550 Peachtree St Ne Medical Office Tower, 9th Floor Atlanta, GA - 303082208 |
| Business Phone Number: | 4046861850 |
| Business Fax Number: | |
| Mailing Address: | 1001 Garden View Dr Ne Apt 617, ATLANTA |
| State: | GA |
| Postal Code: | 303195806 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 07/27/2012 |
| NPI Last Update Date: | 07/27/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | PCET001789 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |