Provider Demographics
NPI:1235567835
Name:MADISON, ALEXANDRA LATHE (AUD)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:LATHE
Last Name:MADISON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:JOYCE
Other - Last Name:LATHE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MDE
Mailing Address - Street 1:677 1/2 W WRIGHTWOOD AVE APT 3N
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-2522
Mailing Address - Country:US
Mailing Address - Phone:216-956-9852
Mailing Address - Fax:
Practice Address - Street 1:225 E CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2991
Practice Address - Country:US
Practice Address - Phone:312-227-8846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-17
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist