Merrill Fahlstrom, SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

248 Issued in ND

Practice address

683 State Ave Ste B
Dickinson, ND 58601-4660

Phone

(701) 483-9400

Fax

(701) 483-9398

NPI assigned

Sep 27, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Omaha Therapy Dba Rehab Visions

  • Physical Therapist
  • Dickinson, ND
  • NPI 1457513418
  NPD (past)
• Omaha Therapy, Inc

  • Rehabilitation Clinic/Center
  • Dickinson, ND
  • NPI 1730280371
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1073604146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "683 STATE AVE STE B",
            "city": "DICKINSON",
            "state": "ND",
            "postal_code": "586014660",
            "telephone_number": "701-483-9400",
            "fax_number": "701-483-9398"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "683 STATE AVE STE B",
            "city": "DICKINSON",
            "state": "ND",
            "postal_code": "586014660",
            "telephone_number": "701-483-9400",
            "fax_number": "701-483-9398"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAHLSTROM",
        "first_name": "MERRILL",
        "credential": "SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "ND",
            "license": "248",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "19349",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "59563",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Evergreen Dickinson, LLC
• Linda A Everson, BA, BS
• Expression Pediatric Therapy, PLLC
• Eyewear Concepts Inc
• Face & Jaw Surgeons, PC
• Brooke Jade Fahsholtz, LCAC
• Fargo Vamc
• Desiree Farrington
• Russell R Fast, LICSW
• Melinda Kaye Faulhaber

• All providers in Dickinson, ND
• Speech-Language Pathologist in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.