Provider Demographics
NPI:1144400516
Name:GUPTA, MADHU (CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:MADHU
Middle Name:
Last Name:GUPTA
Suffix:
Gender:F
Credentials:CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3577 N SHORE DR
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44333-8331
Mailing Address - Country:US
Mailing Address - Phone:330-666-5418
Mailing Address - Fax:
Practice Address - Street 1:3577 N SHORE DR
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44333-8331
Practice Address - Country:US
Practice Address - Phone:330-666-5418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA 01014231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist