Provider Demographics
NPI:1912749169
Name:SPENCE, MADELINE DIANNE
Entity type:Individual
Prefix:MRS
First Name:MADELINE
Middle Name:DIANNE
Last Name:SPENCE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MADELINE
Other - Middle Name:DIANNE
Other - Last Name:GAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:197 HERITAGE MILL TRL
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:TX
Mailing Address - Zip Code:78621-2555
Mailing Address - Country:US
Mailing Address - Phone:210-510-9151
Mailing Address - Fax:
Practice Address - Street 1:1431 GREENWAY DR STE 500
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-2444
Practice Address - Country:US
Practice Address - Phone:877-688-2520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120943235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist