MEDICARE: MADISON PRINCE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	114949	TX

General Provider Information

NPI Number	:	1144877044
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADISON PRINCE

Provider Business Mailing Address
First Line	:	1610 WATERSTON AVE APT 7
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78703-3965
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1610 WATERSTON AVE APT 7
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78703-3965
Country	:	US
Telephone Number	:	504-610-5877
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2019
Last Update Date	:	08/25/2019

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Directions to “ MADISON PRINCE ” Practice Location

Language	Start Address	Practice Location

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