Healthcare Provider Details

I. General information

NPI: 1275488124
Provider Name (Legal Business Name): MADISON CHIAVINI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2026
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 S IRONWOOD DR
APACHE JUNCTION AZ
85120-5002
US

IV. Provider business mailing address

550 S IRONWOOD DR
APACHE JUNCTION AZ
85120-5002
US

V. Phone/Fax

Practice location:
  • Phone: 480-677-7570
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSLPA16655
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: