Provider Demographics
NPI:1912678228
Name:MADSEN, JENNA AZIZA (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:AZIZA
Last Name:MADSEN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 HUNTWOOD LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-2172
Mailing Address - Country:US
Mailing Address - Phone:732-890-9203
Mailing Address - Fax:
Practice Address - Street 1:1005 HUNTWOOD LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-2172
Practice Address - Country:US
Practice Address - Phone:732-890-9203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-26
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty