Provider Demographics
NPI:1306499397
Name:HAUGE, MADISON MARIE
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:MARIE
Last Name:HAUGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BLATT PE CENTER 1300 WHEAT ST ROOM 128
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29208-0001
Mailing Address - Country:US
Mailing Address - Phone:772-323-1876
Mailing Address - Fax:
Practice Address - Street 1:BLATT PE CENTER 1300 WHEAT ST ROOM 128
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29208-0001
Practice Address - Country:US
Practice Address - Phone:772-323-1876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-19
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC5200522255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer