Provider Demographics
NPI:1649855768
Name:JEFFERY, MADISON RAE (MS)
Entity type:Individual
Prefix:MISS
First Name:MADISON
Middle Name:RAE
Last Name:JEFFERY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1132 W MANHATTON DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-4619
Mailing Address - Country:US
Mailing Address - Phone:480-347-7207
Mailing Address - Fax:
Practice Address - Street 1:1132 W MANHATTON DR
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-4619
Practice Address - Country:US
Practice Address - Phone:480-347-7207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-10
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP16212235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist