Provider Demographics
NPI:1962120956
Name:STORY, MADISON (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:STORY
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 1:3816 S NC 16 HWY
Mailing Address - Street 2:
Mailing Address - City:MAIDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28650-8935
Mailing Address - Country:US
Mailing Address - Phone:828-850-1245
Mailing Address - Fax:
Practice Address - Street 1:925 10TH AVENUE DR NW
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-3577
Practice Address - Country:US
Practice Address - Phone:828-850-1245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30000566235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist