Provider Demographics
NPI:1356131957
Name:VERNON, MADELINE REIS
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:REIS
Last Name:VERNON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 S HIGH ST
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:TN
Mailing Address - Zip Code:38382-2034
Mailing Address - Country:US
Mailing Address - Phone:731-487-9563
Mailing Address - Fax:
Practice Address - Street 1:600 S HIGH ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:TN
Practice Address - Zip Code:38382-2034
Practice Address - Country:US
Practice Address - Phone:731-487-9563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist