Healthcare Provider Details

I. General information

NPI: 1538858162
Provider Name (Legal Business Name): MADISON CARTER CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2023
Last Update Date: 10/24/2023
Certification Date: 10/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1599 TOWNSHIP LINE RD
PLAINFIELD IN
46168-7517
US

IV. Provider business mailing address

1599 TOWNSHIP LINE RD
PLAINFIELD IN
46168-7517
US

V. Phone/Fax

Practice location:
  • Phone: 317-914-3176
  • Fax: 844-742-6592
Mailing address:
  • Phone: 317-914-3176
  • Fax: 844-742-6592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number46004193A
License Number StateIN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: