Madeline Lillis, M.S. CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

2202010486 Issued in VA

Practice address

Central Office Address
100 Park Central Plaza Suite 300
Manassas, VA 20111

Phone

(703) 392-1317

NPI assigned

Aug 16, 2022

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Specialty

Qualified Speech Language Pathologist

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1660608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660608000000",
    "number": "1760100838",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "CENTRAL OFFICE ADDRESS",
            "address_2": "100 PARK CENTRAL PLAZA SUITE 300",
            "city": "MANASSAS",
            "state": "VA",
            "postal_code": "20111",
            "telephone_number": "703-392-1317"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "CENTRAL OFFICE ADDRESS",
            "address_2": "100 PARK CENTRAL PLAZA SUITE 300",
            "city": "MANASSAS",
            "state": "VA",
            "postal_code": "20111",
            "telephone_number": "703-392-1317"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LILLIS",
        "first_name": "MADELINE",
        "credential": "M.S. CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-08-16",
        "last_updated": "2022-08-16",
        "certification_date": "2022-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "VA",
            "license": "2202010486",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Speech-Language Pathologist in Manassas, VA
• Providers in Manassas, VA by specialty
• Speech-Language Pathologist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.