Provider Demographics
NPI:1437511946
Name:CALDWELL, MADONNA (MA CCC/SLP)
Entity Type:Individual
Prefix:
First Name:MADONNA
Middle Name:
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:MA CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 BEECH SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:LA
Mailing Address - Zip Code:71251-2013
Mailing Address - Country:US
Mailing Address - Phone:318-259-4435
Mailing Address - Fax:
Practice Address - Street 1:165 BEECH SPRINGS RD
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:LA
Practice Address - Zip Code:71251-2013
Practice Address - Country:US
Practice Address - Phone:318-259-4435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-23
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2741235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist