Provider Demographics
NPI:1326739483
Name:SCAMARDO, MADELYN JUSTINE (MS)
Entity type:Individual
Prefix:MRS
First Name:MADELYN
Middle Name:JUSTINE
Last Name:SCAMARDO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19668 US HIGHWAY 271
Mailing Address - Street 2:
Mailing Address - City:SPIRO
Mailing Address - State:OK
Mailing Address - Zip Code:74959-4454
Mailing Address - Country:US
Mailing Address - Phone:479-652-6458
Mailing Address - Fax:
Practice Address - Street 1:9220 HIGHWAY 71 S STE 10
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72916-9151
Practice Address - Country:US
Practice Address - Phone:479-652-6458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-18
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR202186235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist