Provider Demographics
NPI:1700649217
Name:HANKS, MADISON
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:HANKS
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 1:3256 N 1000 E
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84414-1713
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3D MED BN, 3D MLG, H&S COMPANY, MENTAL HEALTH PLATOON
Practice Address - Street 2:UNIT 38447, OKINAWA JAPAN
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96373-8445
Practice Address - Country:US
Practice Address - Phone:801-516-1424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810008399103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical