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General NPI Number Information
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NPI Number | 1093599441
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Entity Type | Individual
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Provider Name | MADISON WADDILL
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Gender | Female
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Dates
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Enumeration Date | 08/24/2023
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Last Update Date | 08/24/2023
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Provider Practice Location Address
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Address Line | 1200 W 11TH ST
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City | FREEPORT
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State | TX
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Zip | 77541-5346
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Country | US
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Telephone | 979-730-7175
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Fax |
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Provider Business Mailing Address
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Address Line | 55 JALAPENO CT
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City | LAKE JACKSON
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State | TX
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Zip | 77566-6198
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Country | US
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Telephone | 979-248-1999
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 121368
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License Number State | TX
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