Healthcare Provider Details

I. General information

NPI: 1396680393
Provider Name (Legal Business Name): MADISON WHITE SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12313 HIGHWAY 57
VANCLEAVE MS
39565-9501
US

IV. Provider business mailing address

602A BECHTEL BLVD
OCEAN SPRINGS MS
39564-5151
US

V. Phone/Fax

Practice location:
  • Phone: 601-228-2752
  • Fax: 228-366-9062
Mailing address:
  • Phone: 228-249-6358
  • Fax: 228-366-9062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberS-5481
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: