Provider Demographics
NPI:1396351144
Name:SCHANTZ, MADISON ALEXANDRIA (MS, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:MADISON
Middle Name:ALEXANDRIA
Last Name:SCHANTZ
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:10721 CHAPMAN HWY STE 22
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:TN
Mailing Address - Zip Code:37865-4767
Mailing Address - Country:US
Mailing Address - Phone:865-579-2293
Mailing Address - Fax:865-579-2295
Practice Address - Street 1:10721 CHAPMAN HWY STE 22
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:TN
Practice Address - Zip Code:37865-4767
Practice Address - Country:US
Practice Address - Phone:865-579-2293
Practice Address - Fax:865-579-2295
Is Sole Proprietor?:No
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN0000006788235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0000006788OtherSTATE OF TN DEPT OF HEALTH DIVISION OF HEALTH RELATED BOARDS