Healthcare Provider Details

I. General information

NPI: 1831007228
Provider Name (Legal Business Name): MADELYN MCMULLAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1442 SHEPPARD ST
MINDEN LA
71055-3509
US

IV. Provider business mailing address

261 MONTGOMERY DR
SPRINGHILL LA
71075-4959
US

V. Phone/Fax

Practice location:
  • Phone: 318-377-7052
  • Fax:
Mailing address:
  • Phone: 318-578-0739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number10126
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: