Healthcare Provider Details

I. General information

NPI: 1063326734
Provider Name (Legal Business Name): MADISON ELIZABETH HAGEE SLPA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 PROMENADE WAY APT 205
JUPITER FL
33458-3041
US

IV. Provider business mailing address

815 PROMENADE WAY APT 205
JUPITER FL
33458-3041
US

V. Phone/Fax

Practice location:
  • Phone: 937-631-6577
  • Fax:
Mailing address:
  • Phone: 937-631-6577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSI8834
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: