Provider Demographics
NPI:1649328337
Name:MADDEN, LISA GAYLE (MS CCCSLP)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:GAYLE
Last Name:MADDEN
Suffix:
Gender:F
Credentials:MS CCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2184 US HIGHWAY 67 N
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AR
Mailing Address - Zip Code:71857-7754
Mailing Address - Country:US
Mailing Address - Phone:870-703-2188
Mailing Address - Fax:
Practice Address - Street 1:2184 US HIGHWAY 67 N
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AR
Practice Address - Zip Code:71857-7754
Practice Address - Country:US
Practice Address - Phone:870-703-2188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR882235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist