Provider Demographics
NPI:1437724630
Name:HORTON, MADDISON GRACE
Entity Type:Individual
Prefix:
First Name:MADDISON
Middle Name:GRACE
Last Name:HORTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 PRESIDENT GEORGE BUSH HWY APT 10401
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75088-1904
Mailing Address - Country:US
Mailing Address - Phone:870-200-2776
Mailing Address - Fax:
Practice Address - Street 1:600 S BOIS D ARC ST
Practice Address - Street 2:
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-9677
Practice Address - Country:US
Practice Address - Phone:972-564-4055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX411242355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant