Provider Demographics
NPI:1245975309
Name:EWING, PRICILA MADRIGAL (SLP)
Entity type:Individual
Prefix:
First Name:PRICILA
Middle Name:MADRIGAL
Last Name:EWING
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:PRICILA
Other - Middle Name:
Other - Last Name:MADRIGAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:2667 ENTERPRISE RD
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89512-1666
Mailing Address - Country:US
Mailing Address - Phone:530-640-0256
Mailing Address - Fax:
Practice Address - Street 1:2667 ENTERPRISE RD
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89512-1666
Practice Address - Country:US
Practice Address - Phone:530-640-0256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-03
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSP-3110235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist