Provider Demographics
NPI:1083281216
Name:FORD, MADISON (SLP)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:FORD
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 INFIELD CT
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-8026
Mailing Address - Country:US
Mailing Address - Phone:980-444-2770
Mailing Address - Fax:704-799-6825
Practice Address - Street 1:134 INFIELD CT
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8026
Practice Address - Country:US
Practice Address - Phone:980-444-2770
Practice Address - Fax:704-799-6825
Is Sole Proprietor?:No
Enumeration Date:2021-06-07
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2203211235Z00000X
NC30000435235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist