Provider Demographics
NPI:1487089363
Name:DAVID, MADELYN KRIEGER (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MADELYN
Middle Name:KRIEGER
Last Name:DAVID
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 GOOD ST
Mailing Address - Street 2:
Mailing Address - City:BAY ST LOUIS
Mailing Address - State:MS
Mailing Address - Zip Code:39520-8970
Mailing Address - Country:US
Mailing Address - Phone:504-669-0810
Mailing Address - Fax:
Practice Address - Street 1:4552 HIGHWAY 53
Practice Address - Street 2:
Practice Address - City:POPLARVILLE
Practice Address - State:MS
Practice Address - Zip Code:39470-4156
Practice Address - Country:US
Practice Address - Phone:601-795-2043
Practice Address - Fax:601-795-2025
Is Sole Proprietor?:No
Enumeration Date:2013-09-10
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS3225235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0000000Medicaid