Doctor Name: | MADISON SANDROCK |
NPI Number: | 1609200138 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MA, CF-SLP |
License Number: | 7101001631 |
Business Practice Address: | 8481 Holly Rd Grand Blanc, MI - 484391812 |
Business Phone Number: | 8106496382 |
Business Fax Number: | |
Mailing Address: | 20493 Breezeway Dr, MACOMB |
State: | MI |
Postal Code: | 480443517 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 09/03/2013 |
NPI Last Update Date: | 09/03/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 7101001631 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
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 |