Provider Demographics
NPI:1790437507
Name:SHOWALTER, MADELINE A (RBT)
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:A
Last Name:SHOWALTER
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4866 W 135TH ST
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66224-8715
Mailing Address - Country:US
Mailing Address - Phone:832-439-1896
Mailing Address - Fax:
Practice Address - Street 1:4866 W 135TH ST
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66224-8715
Practice Address - Country:US
Practice Address - Phone:832-439-1896
Practice Address - Fax:913-815-4127
Is Sole Proprietor?:No
Enumeration Date:2022-01-23
Last Update Date:2022-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician