Provider Demographics
NPI:1255636411
Name:COMPTON, MADONNA RENEE (SLP)
Entity type:Individual
Prefix:MRS
First Name:MADONNA
Middle Name:RENEE
Last Name:COMPTON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 WOODVIEW DR
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-6809
Mailing Address - Country:US
Mailing Address - Phone:606-677-6732
Mailing Address - Fax:
Practice Address - Street 1:616 WOODVIEW DR
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-6809
Practice Address - Country:US
Practice Address - Phone:606-677-6732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-20
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY 1618235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist