Healthcare Provider Details

I. General information

NPI: 1295655975
Provider Name (Legal Business Name): MADISON LEE OWENS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5455 W 56TH ST
INDIANAPOLIS IN
46254-1301
US

IV. Provider business mailing address

1092 S QUAIL CT
NEW PALESTINE IN
46163-9645
US

V. Phone/Fax

Practice location:
  • Phone: 317-295-7200
  • Fax:
Mailing address:
  • Phone: 888-714-1927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number33014048A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: