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General NPI Number Information
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NPI Number | 1700649217
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Entity Type | Individual
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Provider Name | MADISON HANKS
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Gender | Female
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Dates
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Enumeration Date | 02/06/2024
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Last Update Date | 02/06/2024
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Provider Practice Location Address
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Address Line | 3D MED BN, 3D MLG, H&S COMPANY, MENTAL HEALTH PLATOON UNIT 38447, OKINAWA JAPAN
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City | FPO
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State | AP
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Zip | 96373-8445
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Country | US
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Telephone | 801-516-1424
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Fax |
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Provider Business Mailing Address
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Address Line | 3256 N 1000 E
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City | OGDEN
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State | UT
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Zip | 84414-1713
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0810008399
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License Number State | VA
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