Provider Demographics
NPI:1790597409
Name:MINNITI, MADISON (CCC-SLP)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:MINNITI
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:MADDIE
Other - Middle Name:
Other - Last Name:MINNITI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:421 W TREMONT AVE APT 303
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-6879
Mailing Address - Country:US
Mailing Address - Phone:484-889-7551
Mailing Address - Fax:
Practice Address - Street 1:5113 PIPER STATION DR STE 103
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-6690
Practice Address - Country:US
Practice Address - Phone:704-752-1616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-21
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASLO17719235Z00000X
NC30003201235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist