Healthcare Provider Details

I. General information

NPI: 1962356204
Provider Name (Legal Business Name): MADISON MANNING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2026
Last Update Date: 02/24/2026
Certification Date: 02/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 JENNINGS STATION RD
SAINT LOUIS MO
63121-3323
US

IV. Provider business mailing address

4000 JENNINGS STATION RD
SAINT LOUIS MO
63121-3323
US

V. Phone/Fax

Practice location:
  • Phone: 314-799-3494
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: