Individual
MRS. KELLY ANN MADISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
10405 M ST, OMAHA, NE 68127-1912
(402) 699-9988
Mailing address
10405 M ST, OMAHA, NE 68127-1912
(402) 699-9988
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
1063
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
08707
BCBSNE PROVIDER #
NE
05
—
10025108400
—
NE
01
—
1063
NE LICENSE #
NE
Enumeration date
03/09/2007
Last updated
07/09/2007
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