Healthcare Provider Details

I. General information

NPI: 1508725185
Provider Name (Legal Business Name): RILEY RENE HAGEDORN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 MERCHANT ST STE 103
COLUMBIA MO
65203-5816
US

IV. Provider business mailing address

2912B TROYER DR
COLUMBIA MO
65203-3692
US

V. Phone/Fax

Practice location:
  • Phone: 573-777-8783
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2026020483
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number2023049069
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: