Provider Demographics
NPI:1295480242
Name:SPEAKER, MADISON (MS)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:SPEAKER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 WEBSTER AVE # 2
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02141-1935
Mailing Address - Country:US
Mailing Address - Phone:603-493-5381
Mailing Address - Fax:
Practice Address - Street 1:95 EASTERN AVE STE 8
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-4582
Practice Address - Country:US
Practice Address - Phone:617-996-1210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-18
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA78376-SP-SL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist