Provider Demographics
NPI:1952140907
Name:TICE, MADISON ANN (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:ANN
Last Name:TICE
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 E 25TH ST STE 7
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-5529
Mailing Address - Country:US
Mailing Address - Phone:308-455-1871
Mailing Address - Fax:308-455-1782
Practice Address - Street 1:620 E 25TH ST
Practice Address - Street 2:ST 7
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-5529
Practice Address - Country:US
Practice Address - Phone:308-455-1871
Practice Address - Fax:308-455-1782
Is Sole Proprietor?:No
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2852235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist