Active NPI
Madison Antus, CF-SLP
- Speech-Language Pathologist
- Woodbridge, VA
National Provider Identifier
1710594940
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 2204000573
- Practice address
- 15201 Neabsco Mills Rd
Woodbridge, VA 22191-4005 - Phone
- (703) 583-1405
- NPI assigned
- Oct 1, 2020
- Last updated
- Oct 1, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 2204000573 | VA | Primary |
Addresses
Primary practice location
15201 Neabsco Mills Rd
Woodbridge, VA 22191-4005
Mailing address
505 Roosevelt Blvd Apt B621
Falls Church, VA 22044-3188
Phone (757) 705-1963
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2204000573 | Other | VA | VA BOARD OF HEALTH PROFESSIONS/ BOARD OF AUDIOLOGY AND SPEECH-LANGUAGE PATHOLOGY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2204000573 | VA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1601510400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1601510400000",
"number": "1710594940",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "505 ROOSEVELT BLVD APT B621",
"city": "FALLS CHURCH",
"state": "VA",
"postal_code": "220443188",
"telephone_number": "757-705-1963"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15201 NEABSCO MILLS RD",
"city": "WOODBRIDGE",
"state": "VA",
"postal_code": "221914005",
"telephone_number": "703-583-1405"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANTUS",
"first_name": "MADISON",
"credential": "CF-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-10-01",
"last_updated": "2020-10-01",
"certification_date": "2020-10-01",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "VA",
"license": "2204000573",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VA BOARD OF HEALTH PROFESSIONS/ BOARD OF AUDIOLOGY AND SPEECH-LANGUAGE PATHOLOGY",
"identifier": "2204000573",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Woodbridge, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.