Alysh Oetzel

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

146.016624 Issued in IL

Practice address

4505 W Deyoung St Ste 203C
Marion, IL 62959-5899

Phone

(618) 283-2222

NPI assigned

Jul 16, 2024

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Specialty

Qualified Speech Language Pathologist

Education

Other, 2021

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Synapse Mental Health PLLC

  • Clinical Psychologist
  • Carbondale, IL
  • NPI 1396638847
  Medicare reassignment
• Therapeutic, Education, and Career Services, Inc.

  • Counselor
  • Marion, IL
  • NPI 1043631351
  NPD

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

{
    "created_epoch": "1721088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721088000000",
    "number": "1316785116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 S GLENVIEW DR",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629012245",
            "telephone_number": "309-883-3605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4505 W DEYOUNG ST STE 203C",
            "city": "MARION",
            "state": "IL",
            "postal_code": "629595899",
            "telephone_number": "618-283-2222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OETZEL",
        "first_name": "ALYSH",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-07-16",
        "last_updated": "2024-07-16",
        "certification_date": "2024-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IL",
            "license": "146.016624",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Occupational Performance and Rehab, PC
• Phillip Ray Odle, MSN, RN-BC
• Ashley L Odum, LPN
• Connie Marie Odum
• Joshua Taylor Odum, DPT
• Joe Ogle
• Stephanie Anne Oker, LPN
• Joseph Michael Logan Oldani, DNP-NA, CRNA
• Lindsay Ann Oliveira, PHARM.D.
• Paige Oltmann

• Speech-Language Pathologist in Marion, IL
• Providers in Marion, IL by specialty
• Speech-Language Pathologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.