Healthcare Provider Details

I. General information

NPI: 1346103470
Provider Name (Legal Business Name): MADELYN EAVES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2025
Last Update Date: 12/05/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 COUNTY ROAD 1021
CENTER TX
75935-6415
US

IV. Provider business mailing address

135 COUNTY ROAD 1021
CENTER TX
75935-6415
US

V. Phone/Fax

Practice location:
  • Phone: 936-330-3958
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number43145
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: