Provider Demographics
NPI:1255422861
Name:MADAY, BREA ELIZABETH (MA CCC SLP)
Entity type:Individual
Prefix:MRS
First Name:BREA
Middle Name:ELIZABETH
Last Name:MADAY
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3330 XENIUM LANE N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441
Mailing Address - Country:US
Mailing Address - Phone:763-559-3664
Mailing Address - Fax:
Practice Address - Street 1:900 WEST 94TH STREET
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55420
Practice Address - Country:US
Practice Address - Phone:952-885-0418
Practice Address - Fax:952-885-0173
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6319235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist