Provider Demographics
NPI:1194518787
Name:BRODOSKI, MADISON INNES (MA, CF-SLP)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:INNES
Last Name:BRODOSKI
Suffix:
Gender:F
Credentials:MA, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 AARON DR APT 307
Mailing Address - Street 2:
Mailing Address - City:DEWITT
Mailing Address - State:MI
Mailing Address - Zip Code:48820-7974
Mailing Address - Country:US
Mailing Address - Phone:313-600-6394
Mailing Address - Fax:
Practice Address - Street 1:1161 E CLARK RD STE 360-A
Practice Address - Street 2:
Practice Address - City:DEWITT
Practice Address - State:MI
Practice Address - Zip Code:48820-7930
Practice Address - Country:US
Practice Address - Phone:517-507-5525
Practice Address - Fax:517-507-3085
Is Sole Proprietor?:No
Enumeration Date:2025-05-27
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7152001145235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist