Doctor Name: | MADRA STOUT |
NPI Number: | 1467838649 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | SPEECH-LANGUAGE PATH |
License Number: | 5786 |
Business Practice Address: | 9405 Highway 17 Byp Murrells Inlet, SC - 295769301 |
Business Phone Number: | 4237730488 |
Business Fax Number: | |
Mailing Address: | Po Box 14003, MYRTLE BEACH |
State: | SC |
Postal Code: | 295874003 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 08/10/2015 |
NPI Last Update Date: | 08/10/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 5786 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | SC |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |