Provider Demographics
NPI:1053780643
Name:ACEBO, MADISON CALDWELL (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:CALDWELL
Last Name:ACEBO
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 1:309 MARCH SEA LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-5004
Mailing Address - Country:US
Mailing Address - Phone:501-249-8202
Mailing Address - Fax:
Practice Address - Street 1:160 N NC 241 HWY
Practice Address - Street 2:
Practice Address - City:BEULAVILLE
Practice Address - State:NC
Practice Address - Zip Code:28518-8636
Practice Address - Country:US
Practice Address - Phone:888-258-6905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-24
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15003235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist