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General NPI Number Information
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NPI Number | 1407721798
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Entity Type | Individual
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Provider Name | MADELYN HERNANDEZ
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Gender | Female
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Dates
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Enumeration Date | 10/07/2025
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Last Update Date | 10/07/2025
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Provider Practice Location Address
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Address Line | 745 CRAIG RD STE 307
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City | CREVE COEUR
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State | MO
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Zip | 63141-7122
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Country | US
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Telephone | 314-722-6879
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Fax |
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Provider Business Mailing Address
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Address Line | 12391 TRIBUTARY DR # 2191J
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City | MARYLAND HEIGHTS
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State | MO
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Zip | 63043-2178
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Country | US
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Telephone | 314-756-7888
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 2025036966
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License Number State | MO
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