Provider Demographics
NPI:1730966441
Name:LAVELLE, MADISON ELIZABETH
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:ELIZABETH
Last Name:LAVELLE
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 1:11705 SAN JOSE BLVD STE 111
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-1653
Mailing Address - Country:US
Mailing Address - Phone:904-345-7450
Mailing Address - Fax:
Practice Address - Street 1:11705 SAN JOSE BLVD STE 111
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-1653
Practice Address - Country:US
Practice Address - Phone:904-345-7450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist