Provider Demographics
NPI:1609563048
Name:HAUN, MADISON SHAE
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:SHAE
Last Name:HAUN
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 1:448 E BRAIDHILL DR
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-5571
Mailing Address - Country:US
Mailing Address - Phone:308-220-8691
Mailing Address - Fax:
Practice Address - Street 1:7213 N SILVER CREEK WAY
Practice Address - Street 2:
Practice Address - City:EAGLE MOUNTAIN
Practice Address - State:UT
Practice Address - Zip Code:84005-5191
Practice Address - Country:US
Practice Address - Phone:801-980-1510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14290337235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist