Healthcare Provider Details

I. General information

NPI: 1831864420
Provider Name (Legal Business Name): MADISON BROOKE HANNAH-THREADGILL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2021
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 MERCHANT ST
SPRINGDALE OH
45246-3735
US

IV. Provider business mailing address

2616 RIVER RD
HAMILTON OH
45015-1459
US

V. Phone/Fax

Practice location:
  • Phone: 513-771-9600
  • Fax:
Mailing address:
  • Phone: 513-341-8065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.2608545
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: