Provider Demographics
NPI:1366179558
Name:DAVIS, MADISON MARIA
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:MARIA
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 NASTURTIUM LN
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19054-3801
Mailing Address - Country:US
Mailing Address - Phone:267-316-8164
Mailing Address - Fax:
Practice Address - Street 1:303 BANK AVE
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:NJ
Practice Address - Zip Code:08077-1113
Practice Address - Country:US
Practice Address - Phone:856-829-2274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-07
Last Update Date:2022-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJTL-3905235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist