Provider Demographics
NPI:1912479403
Name:HUDDLESTON, MADELINE KATE (SLP ASSISTANT)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:KATE
Last Name:HUDDLESTON
Suffix:
Gender:F
Credentials:SLP ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19241 DAVID MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:SHENADOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77381
Mailing Address - Country:US
Mailing Address - Phone:936-321-8300
Mailing Address - Fax:
Practice Address - Street 1:3728 S US HIGHWAY 287
Practice Address - Street 2:
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75109-8960
Practice Address - Country:US
Practice Address - Phone:903-874-6315
Practice Address - Fax:903-874-6315
Is Sole Proprietor?:No
Enumeration Date:2018-12-20
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX122270235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist