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NPI Code Detail

MEDICARE: MADELINE EZELL MS, CCC-SLP

MEDICARE: MADELINE EZELL MS, CCC-SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist6111AL

General Provider Information

NPI Number : 1780514919
Entity Type Code : Individual
Provider Name (Legal Business Name) : MADELINE EZELL MS, CCC-SLP
Provider Business Mailing Address
First Line : 3775 ROSS CLARK CIR
Second Line :
City : DOTHAN
State : AL
Zip : 36303-2251
Country : US
Telephone Number : 334-316-0191
Fax Number :
Provider Business Practice Location Address
First Line : 3775 ROSS CLARK CIR
Second Line :
City : DOTHAN
State : AL
Zip : 36303-2251
Country : US
Telephone Number : 334-316-0191
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/20/2026
Last Update Date : 05/20/2026

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Directions to “ MADELINE EZELL MS, CCC-SLP” Practice Location

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