Provider Demographics
NPI:1114736683
Name:MCCORMICK, MADISON BROOKE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:BROOKE
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37160-5017
Mailing Address - Country:US
Mailing Address - Phone:931-619-0949
Mailing Address - Fax:
Practice Address - Street 1:1805 VALLEY RD
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37160-5017
Practice Address - Country:US
Practice Address - Phone:931-619-0949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-30
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8377235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist