Provider Demographics
NPI:1447803838
Name:COWAN-BANKER, MADISON P
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:P
Last Name:COWAN-BANKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:P
Other - Last Name:THODE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:144 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:FARRAGUT
Mailing Address - State:TN
Mailing Address - Zip Code:37934-2901
Mailing Address - Country:US
Mailing Address - Phone:865-777-1727
Mailing Address - Fax:865-966-0942
Practice Address - Street 1:144 CONCORD RD
Practice Address - Street 2:
Practice Address - City:FARRAGUT
Practice Address - State:TN
Practice Address - Zip Code:37934-2901
Practice Address - Country:US
Practice Address - Phone:865-777-1727
Practice Address - Fax:865-966-0942
Is Sole Proprietor?:No
Enumeration Date:2019-07-24
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1867237600000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter