Provider Demographics
NPI:1437687787
Name:CORRIGAN-ALDA, MADISON RAE
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:RAE
Last Name:CORRIGAN-ALDA
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 1:470 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-1000
Mailing Address - Country:US
Mailing Address - Phone:614-582-1245
Mailing Address - Fax:
Practice Address - Street 1:5500 E BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-1476
Practice Address - Country:US
Practice Address - Phone:614-575-9003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-31
Last Update Date:2017-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2017237235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist