MEDICARE: MADISON HENN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1164995320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADISON HENN

Provider Business Mailing Address
First Line	:	1321 MURFREESBORO PIKE STE 702
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37217-2679
Country	:	US
Telephone Number	:	615-361-4000
Fax Number	:	615-815-1946

Provider Business Practice Location Address
First Line	:	100 FORBES DR
Second Line	:
City	:	HOPKINSVILLE
State	:	KY
Zip	:	42240-7200
Country	:	US
Telephone Number	:	270-215-5945
Fax Number	:	615-815-1946

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2019
Last Update Date	:	07/24/2021

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Directions to “ MADISON HENN ” Practice Location

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