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NPI Code Detail

MEDICARE: MADISON LEIGH EVANS M.S. CF

MEDICARE: MADISON LEIGH EVANS M.S. CF
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
1235Z00000XSpeech-Language Pathologist

General Provider Information

NPI Number : 1417579806
Entity Type Code : Individual
Provider Name (Legal Business Name) : MADISON LEIGH EVANS M.S. CF
Provider Business Mailing Address
First Line : 100 W RAMSEY ST
Second Line :
City : DAWSON SPRINGS
State : KY
Zip : 42408-1739
Country : US
Telephone Number : 270-797-8131
Fax Number :
Provider Business Practice Location Address
First Line : 100 W RAMSEY ST
Second Line :
City : DAWSON SPRINGS
State : KY
Zip : 42408-1739
Country : US
Telephone Number : 270-797-8131
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/08/2020
Last Update Date : 05/08/2020

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Directions to “ MADISON LEIGH EVANS M.S. CF” Practice Location

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