Healthcare Provider Details

I. General information

NPI: 1831093947
Provider Name (Legal Business Name): MADELYN REXILIUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MADELYN JOHNSON

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1633 E WINCHESTER BLVD
COLLIERVILLE TN
38017-4214
US

IV. Provider business mailing address

PO BOX 932184
ATLANTA GA
31193-2184
US

V. Phone/Fax

Practice location:
  • Phone: 904-618-3778
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number8964
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: