Healthcare Provider Details

I. General information

NPI: 1730942269
Provider Name (Legal Business Name): MADISON RAE MORITZ MCD CF-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2024
Last Update Date: 02/13/2024
Certification Date: 02/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10310 W MARKHAM ST STE 201
LITTLE ROCK AR
72205-1579
US

IV. Provider business mailing address

1601 LYNNWOOD
BENTON AR
72015-3137
US

V. Phone/Fax

Practice location:
  • Phone: 501-406-7910
  • Fax:
Mailing address:
  • Phone: 501-607-0099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number202566
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: