Provider Demographics
NPI:1033194881
Name:MADONIA, SUSAN JOYCE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:JOYCE
Last Name:MADONIA
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 NE 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-8007
Mailing Address - Country:US
Mailing Address - Phone:561-866-9747
Mailing Address - Fax:561-362-4067
Practice Address - Street 1:2201 NE 3RD AVE
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-8007
Practice Address - Country:US
Practice Address - Phone:561-866-9747
Practice Address - Fax:361-362-4067
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-14
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA7246235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL887476000Medicaid