Healthcare Provider Details

I. General information

NPI: 1720757156
Provider Name (Legal Business Name): MADISON RAEANN MAYS M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2021
Last Update Date: 09/16/2021
Certification Date: 09/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 KOSCIUSKO ST
WARSAW MO
65355
US

IV. Provider business mailing address

206 E CARMAN RD
EL DORADO SPRINGS MO
64744-2203
US

V. Phone/Fax

Practice location:
  • Phone: 604-386-2606
  • Fax:
Mailing address:
  • Phone: 417-296-3106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2020018834
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: