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General NPI Number Information
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NPI Number | 1720911712
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Entity Type | Individual
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Provider Name | MADELYN SIMMONS
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Gender | Female
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Dates
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Enumeration Date | 06/08/2026
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Last Update Date | 06/08/2026
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Provider Practice Location Address
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Address Line | 1315 2ND ST SW STE 202
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City | ROANOKE
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State | VA
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Zip | 24016-4935
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Country | US
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Telephone | 540-982-2208
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Fax |
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Provider Business Mailing Address
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Address Line | 2562 ORANGE AVE NE APT 105
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City | ROANOKE
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State | VA
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Zip | 24012-6291
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Country | US
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Telephone |
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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 | 2204001810
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License Number State | VA
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