MEDICARE: MADISON LYNN POTTER LCSW

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
1	1041C0700X	Clinical Social Worker	2024042660	MO

General Provider Information

NPI Number	:	1730873134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADISON LYNN POTTER LCSW

Provider Business Mailing Address
First Line	:	967 GARDENVIEW OFFICE PKWY
Second Line	:
City	:	CREVE COEUR
State	:	MO
Zip	:	63141-5917
Country	:	US
Telephone Number	:	314-561-9757
Fax Number	:

Provider Business Practice Location Address
First Line	:	967 GARDENVIEW OFFICE PKWY
Second Line	:
City	:	CREVE COEUR
State	:	MO
Zip	:	63141-5917
Country	:	US
Telephone Number	:	314-561-9757
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2023
Last Update Date	:	12/02/2025

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