Provider Demographics
NPI:1770110629
Name:ANDERSON, MADELINE MICHELLE (HID)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:MICHELLE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:HID
Other - Prefix:MISS
Other - First Name:MADELINE
Other - Middle Name:
Other - Last Name:BEETS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2901 LAVENDER PKWY STE 130
Mailing Address - Street 2:
Mailing Address - City:FARIBAULT
Mailing Address - State:MN
Mailing Address - Zip Code:55021-5087
Mailing Address - Country:US
Mailing Address - Phone:507-333-3932
Mailing Address - Fax:507-332-3011
Practice Address - Street 1:2901 LAVENDER PKWY STE 130
Practice Address - Street 2:
Practice Address - City:FARIBAULT
Practice Address - State:MN
Practice Address - Zip Code:55021-5087
Practice Address - Country:US
Practice Address - Phone:507-333-3932
Practice Address - Fax:507-332-3011
Is Sole Proprietor?:No
Enumeration Date:2020-03-23
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2854237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist