Madalyn Marie Petrovich, M.S., CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

28402 Issued in CA

Practice address

10780 Santa Monica Blvd Ste 405
Los Angeles, CA 90025-7655

Phone

(310) 234-0300

NPI assigned

Jul 2, 2019

Sex

Female

Sole proprietor

No

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

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1562025600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1562025600000",
    "number": "1942862693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 N OAKHURST DR APT 105",
            "city": "BEVERLY HILLS",
            "state": "CA",
            "postal_code": "902103913",
            "telephone_number": "203-770-8293"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10780 SANTA MONICA BLVD STE 405",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900257655",
            "telephone_number": "310-234-0300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETROVICH",
        "first_name": "MADALYN",
        "middle_name": "MARIE",
        "name_prefix": "Miss",
        "credential": "M.S., CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-02",
        "last_updated": "2019-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "CA",
            "license": "28402",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Romela Petrosyan, M.D.
• Shushan Petrosyan
• Jelica Petrovic
• Lidija Petrovic, MD
• Nataly Seka Petrovic, LCSW
• Henrik Petrowsky, MD
• Richard Edward Petrucci Jr., MD
• Bertha Alexis Pettaway, LCSW
• Moritz Sebastian Pettenkofer, MD
• Regina Petterson, PSY.D.

• Speech-Language Pathologist in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Speech-Language Pathologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.