Provider Demographics
NPI:1467212894
Name:OVERWEIN, MADISON
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:OVERWEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:733 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:TAYLOR MILL
Mailing Address - State:KY
Mailing Address - Zip Code:41015-2223
Mailing Address - Country:US
Mailing Address - Phone:859-669-6299
Mailing Address - Fax:
Practice Address - Street 1:73 CAVALIER BLVD STE 309
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-5183
Practice Address - Country:US
Practice Address - Phone:513-787-1421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY287762101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health