Provider Demographics
NPI:1689427973
Name:SPANN, MADISON ELAINE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:ELAINE
Last Name:SPANN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 STONEWALL JACKSON DR UNIT 6
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTON
Mailing Address - State:TN
Mailing Address - Zip Code:37643-2998
Mailing Address - Country:US
Mailing Address - Phone:423-841-8714
Mailing Address - Fax:
Practice Address - Street 1:301 S WATAUGA AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643-3546
Practice Address - Country:US
Practice Address - Phone:423-542-6512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist