Individual
MADISON ANTUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CF-SLP
Contact information
Practice address
15201 NEABSCO MILLS RD, WOODBRIDGE, VA 22191-4005
(703) 583-1405
Mailing address
505 ROOSEVELT BLVD APT B621, FALLS CHURCH, VA 22044-3188
(757) 705-1963
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2204000573
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2204000573
VA BOARD OF HEALTH PROFESSIONS/ BOARD OF AUDIOLOGY AND SPEECH-LANGUAGE PATHOLOGY
VA
Enumeration date
10/01/2020
Last updated
10/01/2020
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