Basic Information
Provider Information
NPI: 1003294778
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PLUMMER
FirstName: MADISON
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: M.S., CCC-SLP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 6186 SEASIDE DRIVE
Address2:  
City: NEW PORT RICHEY
State: FL
PostalCode: 34652
CountryCode: US
TelephoneNumber: 7278101105
FaxNumber:  
Practice Location
Address1: 6186 SEASIDE DRIVE
Address2:  
City: NEW PORT RICHEY
State: FL
PostalCode: 34652
CountryCode: US
TelephoneNumber: 7278101105
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/13/2015
LastUpdateDate: 06/30/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/30/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
235Z00000XSA17618FLY Speech, Language and Hearing Service ProvidersSpeech-Language Pathologist 
103K00000X  N Behavioral Health & Social Service ProvidersBehavioral Analyst 

No ID Information.


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