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NPI Code Detail

MEDICARE: MADISON LYNN VANDYKE LMSW

MEDICARE: MADISON LYNN VANDYKE LMSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker2025031666MO

General Provider Information

NPI Number : 1417834425
Entity Type Code : Individual
Provider Name (Legal Business Name) : MADISON LYNN VANDYKE LMSW
Provider Business Mailing Address
First Line : 900 E LAHARPE ST
Second Line :
City : KIRKSVILLE
State : MO
Zip : 63501-4520
Country : US
Telephone Number : 417-761-5000
Fax Number : 417-761-5011
Provider Business Practice Location Address
First Line : 1628 OKLAHOMA AVE
Second Line :
City : TRENTON
State : MO
Zip : 64683-2565
Country : US
Telephone Number : 660-359-4600
Fax Number : 660-359-4286
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/20/2025
Last Update Date : 02/09/2026

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