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NPI Code Detail

MEDICARE: MADISON MINNITI CCC-SLP

MEDICARE: MADISON MINNITI 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 PathologistSLO17719PA
2235Z00000XSpeech-Language Pathologist30003201NC

General Provider Information

NPI Number : 1790597409
Entity Type Code : Individual
Provider Name (Legal Business Name) : MADISON MINNITI CCC-SLP
Provider Business Mailing Address
First Line : 421 W TREMONT AVE APT 303
Second Line :
City : CHARLOTTE
State : NC
Zip : 28203-6879
Country : US
Telephone Number : 484-889-7551
Fax Number :
Provider Business Practice Location Address
First Line : 5113 PIPER STATION DR STE 103
Second Line :
City : CHARLOTTE
State : NC
Zip : 28277-6690
Country : US
Telephone Number : 704-752-1616
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/21/2025
Last Update Date : 01/21/2025

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Directions to “ MADISON MINNITI CCC-SLP” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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