Healthcare Provider Details

I. General information

NPI: 1891406559
Provider Name (Legal Business Name): MADISON ANNE LUNN SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2022
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87225 CHURCH ST
THERMAL CA
92274-8901
US

IV. Provider business mailing address

82130 WELLS LN UNIT 3
THERMAL CA
92274-6774
US

V. Phone/Fax

Practice location:
  • Phone: 760-399-5137
  • Fax:
Mailing address:
  • Phone: 480-298-2598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP17410
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number41902
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: