Provider Demographics
NPI:1407582687
Name:HOWARD, MADISON (SLP)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:HOWARD
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 1:287 HUTCHISON RD
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:KY
Mailing Address - Zip Code:40361-9005
Mailing Address - Country:US
Mailing Address - Phone:606-584-1169
Mailing Address - Fax:
Practice Address - Street 1:287 HUTCHISON RD
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:KY
Practice Address - Zip Code:40361-9005
Practice Address - Country:US
Practice Address - Phone:606-584-1169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY277991235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY277991OtherKENTUCKY BOARD OF SPEECH-LANGUAGE PATHOLOGY & AUDILOGY