Provider Demographics
NPI:1326395666
Name:STONESTREET, MADISON JAN (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MADISON
Middle Name:JAN
Last Name:STONESTREET
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:4443 N JOSEY LN STE 100
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-4677
Mailing Address - Country:US
Mailing Address - Phone:972-394-8900
Mailing Address - Fax:
Practice Address - Street 1:4443 N JOSEY LN STE 100
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4677
Practice Address - Country:US
Practice Address - Phone:972-394-8900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-06
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111550235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111550OtherTEXAS STATE SPEECH PATHOLOGY LICENSE
14068573OtherASHA NATIONAL LICENSE