Mary Ellen Boedeker

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

0383563 Issued in MO

Practice address

12555 Partridge Run Dr
Florissant, MO 63033-5015

Phone

(314) 953-7600

NPI assigned

Apr 13, 2018

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

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.

• Hazelwood School District

  • Local Education Agency (LEA)
  • Florissant, MO
  • NPI 1265578173
  NPD (past)

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

{
    "created_epoch": "1523577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1523577600000",
    "number": "1366939548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15955 NEW HALLS FERRY RD",
            "city": "FLORISSANT",
            "state": "MO",
            "postal_code": "630311298",
            "telephone_number": "314-953-4991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12555 PARTRIDGE RUN DR",
            "city": "FLORISSANT",
            "state": "MO",
            "postal_code": "630335015",
            "telephone_number": "314-953-7600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOEDEKER",
        "first_name": "MARY",
        "middle_name": "ELLEN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-13",
        "last_updated": "2018-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MO",
            "license": "0383563",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lisa L Bloodworth
• Akyenaa K Boadi, LPC
• Boain Dental Care
• Jennifer Boain, D.D.S.
• John Christopher Boain, D.D.S.
• Armene Metrice Bolden
• Bryce Jalen Bolden
• Bond Care Home Health, LLC
• Bond Care Home Health, LLC
• Bond Medical Supply, Inc.

• Speech-Language Pathologist in Florissant, MO
• Providers in Florissant, MO by specialty
• Speech-Language Pathologist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2018; 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.