Healthcare Provider Details

I. General information

NPI: 1134741374
Provider Name (Legal Business Name): MADISON RICE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2020
Last Update Date: 02/17/2026
Certification Date: 02/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 N GORE AVE
SAINT LOUIS MO
63119-1600
US

IV. Provider business mailing address

5393 ROYAL HILLS DR
SAINT LOUIS MO
63129-2310
US

V. Phone/Fax

Practice location:
  • Phone: 844-424-3577
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2019026937
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: