Provider Demographics
NPI:1619092137
Name:MADIX, STEVEN GLEN (PHD, CCC-A-SLP)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:GLEN
Last Name:MADIX
Suffix:
Gender:M
Credentials:PHD, CCC-A-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 ROBINSON HALL
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71272-0001
Mailing Address - Country:US
Mailing Address - Phone:318-257-4764
Mailing Address - Fax:318-257-4492
Practice Address - Street 1:120 ROBINSON HALL
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71272-0001
Practice Address - Country:US
Practice Address - Phone:318-257-4764
Practice Address - Fax:318-257-4492
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5076231HA2400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner