Healthcare Provider Details

I. General information

NPI: 1740190503
Provider Name (Legal Business Name): MADISON LYNN HAYES-GOWEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3775 ATHENA SCHOOL RD
DE SOTO MO
63020-4588
US

IV. Provider business mailing address

3775 ATHENA SCHOOL RD
DE SOTO MO
63020-4588
US

V. Phone/Fax

Practice location:
  • Phone: 636-586-1020
  • Fax: 636-586-1029
Mailing address:
  • Phone: 636-586-1020
  • Fax: 636-586-1029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2026039876
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: