Individual
MADISON BAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3545 S NATIONAL AVE, SPRINGFIELD, MO 65807-7310
(417) 269-9668
Mailing address
3545 S NATIONAL AVE, SPRINGFIELD, MO 65807-7310
(417) 269-9668
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2022029309
MO
Other
Enumeration date
08/03/2022
Last updated
08/03/2022
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