=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164354585
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MADISON STELLY
-----------------------------------------------------
Gender |
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/01/2026
-----------------------------------------------------
Last Update Date | 06/01/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | PO BOX 1593
-----------------------------------------------------
City | SAINT FRANCISVILLE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70775-1593
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-245-5170
-----------------------------------------------------
Fax | 225-308-3223
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1593
-----------------------------------------------------
City | SAINT FRANCISVILLE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70775-1593
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-245-5170
-----------------------------------------------------
Fax | 225-308-3223
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 10162
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------