Provider Demographics
NPI:1942400387
Name:MADISON SPEECH ASSOCIATES, INC
Entity Type:Organization
Organization Name:MADISON SPEECH ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:P
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:MCD,CCC-SLP
Authorized Official - Phone:256-464-9464
Mailing Address - Street 1:103 INTERCOM DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-2640
Mailing Address - Country:US
Mailing Address - Phone:256-464-9464
Mailing Address - Fax:256-325-9469
Practice Address - Street 1:103 INTERCOM DR
Practice Address - Street 2:SUITE C
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-2640
Practice Address - Country:US
Practice Address - Phone:256-464-9464
Practice Address - Fax:256-325-9469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2301235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51536066OtherBLUE CROSS BLUE SHIELD
AL529929330Medicaid
AL=========OtherTRICARE