Provider Demographics
NPI:1972753978
Name:MADSON, GINA R (AUD)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:R
Last Name:MADSON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 MEDICAL CENTER PT
Mailing Address - Street 2:SUITE 180
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-8731
Mailing Address - Country:US
Mailing Address - Phone:719-667-1327
Mailing Address - Fax:719-667-1328
Practice Address - Street 1:1625 MEDICAL CENTER PT
Practice Address - Street 2:SUITE 180
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-8731
Practice Address - Country:US
Practice Address - Phone:719-667-1327
Practice Address - Fax:719-667-1328
Is Sole Proprietor?:No
Enumeration Date:2008-09-25
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO514231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist