Madeline Rose Ingram, MS SLP
Individual provider Active NPI Speech-Language Pathologist · Manteno, IL
NPI 1891353363 · NPPES record last updated Apr 29, 2024
Key facts
- NPI
- 1891353363
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- 146017611 (IL)
- Practice address
- 10 N Locust St Ste 2
Manteno, IL 60950-1500 - Phone
- (815) 263-5001
- NPI assigned
- May 30, 2019
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Qualified Speech Language Pathologist
- Education
- Other, 2022
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Expressable Speech-Language Pathology PC
Practice addresses (Care Compare)
5 Revere Dr
Northbrook, IL 60062-1566
Phone (512) 399-0064
633 W 5TH St
Ofc 2876B
Los Angeles, CA 90071-2005
Phone (512) 399-0064
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in IL, CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240510002705 | IL | Practitioner - Qualified Speech Language Pathologist | 6103267935 | Reassigns benefits to 1 organization |
| I20240618002743 | CA | Practitioner - Qualified Speech Language Pathologist | 6103267935 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 146017611 | IL | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Expressable Speech-Language Pathology, P.C. | Speech-Language Pathologist | Current |
Accepting new patients |
Locations
633 W 5th St
Los Angeles, CA 90071
Phone (213) 260-1286
633 W 5th St
Ofc 2876B
Los Angeles, CA 90071
5 Revere Dr
Ste 200
Northbrook, IL 60062
Phone (630) 291-3206
5 Revere Dr
#One
Northbrook, IL 60062
7600 Chevy Chase Dr
Ste 300
Austin, TX 78752
Phone (512) 318-2503
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | |||
| Speech-Language Pathologist | 235Z00000X | 146017611 | IL | Yes |
Addresses
Primary practice location
10 N Locust St Ste 2
Manteno, IL 60950-1500
Mailing address
2862 S Southbrook Dr
Kankakee, IL 60901-7198
Phone (815) 263-5001
Other names
- Madeline Goetz
Other providers in Manteno, IL
- Rebecca J Hodulik
- Elizabeth M Hofmeister
- Maeve Houlihan
- Adele Human
- Illinois Veterans Home at Manteno
- Iroquois Mental Health Center
- Iroquois Mental Health Center
- Jeffrey Jackson
- Gregory Jen
- Betul Kan
All providers in Manteno, IL · Speech-Language Pathologist in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 29, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.