Provider Demographics
NPI:1245484401
Name:MADISON, RANDI LOREN (MA CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:RANDI
Middle Name:LOREN
Last Name:MADISON
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 1:3 TOWN HOUSE PL
Mailing Address - Street 2:APT 3A
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-3232
Mailing Address - Country:US
Mailing Address - Phone:516-467-4923
Mailing Address - Fax:
Practice Address - Street 1:3 TOWN HOUSE PL
Practice Address - Street 2:APT 3A
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-3232
Practice Address - Country:US
Practice Address - Phone:516-467-4923
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-13
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015391-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist