Provider Demographics
NPI:1417579806
Name:EVANS, MADISON LEIGH (MS CF)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:LEIGH
Last Name:EVANS
Suffix:
Gender:F
Credentials:MS CF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 W RAMSEY ST
Mailing Address - Street 2:
Mailing Address - City:DAWSON SPRINGS
Mailing Address - State:KY
Mailing Address - Zip Code:42408-1739
Mailing Address - Country:US
Mailing Address - Phone:270-797-8131
Mailing Address - Fax:
Practice Address - Street 1:100 W RAMSEY ST
Practice Address - Street 2:
Practice Address - City:DAWSON SPRINGS
Practice Address - State:KY
Practice Address - Zip Code:42408-1739
Practice Address - Country:US
Practice Address - Phone:270-797-8131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-08
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist