Provider Demographics
NPI:1235625971
Name:PLUNK, MADISON TAELOR (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:TAELOR
Last Name:PLUNK
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:TAELOR
Other - Last Name:WELLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:537 LONE OAK DR
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-2166
Mailing Address - Country:US
Mailing Address - Phone:580-704-6234
Mailing Address - Fax:
Practice Address - Street 1:940 SW 84TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-9255
Practice Address - Country:US
Practice Address - Phone:405-636-0626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-05
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4506235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist