Provider Demographics
NPI:1003292913
Name:LEVINE, MADISON
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:LEVINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3121 SPRINGBANK LN
Mailing Address - Street 2:UNIT G
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-3346
Mailing Address - Country:US
Mailing Address - Phone:704-540-3081
Mailing Address - Fax:
Practice Address - Street 1:3121 SPRINGBANK LN
Practice Address - Street 2:UNIT G
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-3346
Practice Address - Country:US
Practice Address - Phone:704-540-3081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-03
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1468237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist