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General NPI Number Information
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NPI Number | 1952660367
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Entity Type | Individual
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Provider Name | KATIE H CANNON M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/07/2012
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Last Update Date | 03/17/2025
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Provider Practice Location Address
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Address Line | 301 TROY DR
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City | MADISON
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State | WI
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Zip | 53704-1521
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Country | US
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Telephone | 608-301-1000
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Fax | 608-301-1390
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Provider Business Mailing Address
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Address Line | 5618 FRASER CIR APT 319
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City | MADISON
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State | WI
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Zip | 53718-4414
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Country | US
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Telephone | 218-213-2281
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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 | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 61609
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License Number State | WI
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