Active NPI
Madeleine Pethan, M.A., CCC-SLP
- Speech-Language Pathologist
- Charlotte, NC
National Provider Identifier
1053667089
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 12104
- Practice address
- 6035 Fairview Rd
Charlotte, NC 28210-3256 - Phone
- (704) 295-3000
- NPI assigned
- Jul 27, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | PCET001789 | GA | |
| Speech-Language Pathologist | 235Z00000X | 12104 | NC | Primary |
Addresses
Primary practice location
6035 Fairview Rd
Charlotte, NC 28210-3256
Mailing address
6035 Fairview Rd
Charlotte, NC 28210-3256
Phone (704) 295-3000
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053667089 | Medicaid | NC | |
| 1260932 | Other | SC | WELLCARE |
| SAN138 | Medicaid | SC | |
| 19KQ3 | Other | NC | BCBSNC |
| 4808956 | Other | AETNA |
Other names 1
- Mrs. Madeleine Haugh
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PCET001789 | GA | MD | Speech-Language Pathologist |
| 12104 | NC | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1343347200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1497484800000",
"number": "1053667089",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6035 FAIRVIEW RD",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282103256",
"telephone_number": "704-295-3000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6035 FAIRVIEW RD",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282103256",
"telephone_number": "704-295-3000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETHAN",
"first_name": "MADELEINE",
"name_prefix": "Mrs.",
"credential": "M.A., CCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-07-27",
"last_updated": "2017-06-15",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "GA",
"license": "PCET001789",
"primary": false
},
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "NC",
"license": "12104",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1053667089",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WELLCARE",
"identifier": "1260932",
"state": "SC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "SAN138",
"state": "SC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBSNC",
"identifier": "19KQ3",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "4808956",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"first_name": "MADELEINE",
"last_name": "HAUGH",
"prefix": "MRS.",
"credential": "M.A., CCC-SLP",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Charlotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.