Provider Demographics
NPI:1427662006
Name:STAPLES, MADISON (MS, CF-SLP)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:STAPLES
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 E GREENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-2745
Mailing Address - Country:US
Mailing Address - Phone:385-444-5450
Mailing Address - Fax:
Practice Address - Street 1:570 E GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-2745
Practice Address - Country:US
Practice Address - Phone:385-444-5450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-01
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11883739235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist