Provider Demographics
NPI:1730942269
Name:MORITZ, MADISON RAE (MCD CF-SLP)
Entity type:Individual
Prefix:MISS
First Name:MADISON
Middle Name:RAE
Last Name:MORITZ
Suffix:
Gender:F
Credentials:MCD CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 LYNNWOOD
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72015-3137
Mailing Address - Country:US
Mailing Address - Phone:501-607-0099
Mailing Address - Fax:
Practice Address - Street 1:10310 W MARKHAM ST STE 201
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-1579
Practice Address - Country:US
Practice Address - Phone:501-406-7910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-06
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
AR202566235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist