Provider Demographics
NPI:1417638511
Name:PACKER, MADISON MARIE (AUD)
Entity Type:Individual
Prefix:DR
First Name:MADISON
Middle Name:MARIE
Last Name:PACKER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8901 W 74TH ST STE 147
Mailing Address - Street 2:
Mailing Address - City:MERRIAM
Mailing Address - State:KS
Mailing Address - Zip Code:66204-2201
Mailing Address - Country:US
Mailing Address - Phone:913-404-5400
Mailing Address - Fax:
Practice Address - Street 1:8901 W 74TH ST
Practice Address - Street 2:STE 147
Practice Address - City:MERRIAM
Practice Address - State:KS
Practice Address - Zip Code:66204-2201
Practice Address - Country:US
Practice Address - Phone:913-404-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2484237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter