Provider Demographics
NPI:1851122584
Name:AUTEN, MADALYN RAE
Entity type:Individual
Prefix:
First Name:MADALYN
Middle Name:RAE
Last Name:AUTEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MADALYN
Other - Middle Name:RAE
Other - Last Name:BECKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:96 ORCHARD LN
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-4927
Mailing Address - Country:US
Mailing Address - Phone:740-839-9633
Mailing Address - Fax:
Practice Address - Street 1:60901 BEECH GROVE LN
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-8909
Practice Address - Country:US
Practice Address - Phone:740-432-6952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOND.20242886-SP235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist