Provider Demographics
NPI:1285340331
Name:MADISON SPEECH THERAPY LLC
Entity type:Organization
Organization Name:MADISON SPEECH THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SEVERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-313-5632
Mailing Address - Street 1:613 SHEARWATER ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53714-3351
Mailing Address - Country:US
Mailing Address - Phone:608-313-5632
Mailing Address - Fax:608-716-3130
Practice Address - Street 1:613 SHEARWATER ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53714-3351
Practice Address - Country:US
Practice Address - Phone:608-313-5632
Practice Address - Fax:608-716-3130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty