Angela Sue Creasy, SLP
Individual provider Active NPI Speech-Language Pathologist · Lake Ozark, MO
NPI 1396383113 · NPPES record last updated Dec 11, 2019
Key facts
- NPI
- 1396383113
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- 115840 (MO)
- Practice address
- 202 Pawnee Rd
Lake Ozark, MO 65049-4946 - Phone
- (309) 255-0517
- NPI assigned
- Dec 11, 2019
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 8
Medicare Care Compare profile
- Specialty
- Qualified Speech Language Pathologist
- Education
- Other, 1997
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Empowerme Rehabilitation Illinois LLC
Practice addresses (Care Compare)
7108 Marine Rd
Edwardsville, IL 62025-4282
Phone (618) 706-9759
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20221013000618 | IL | Practitioner - Qualified Speech Language Pathologist | 1557743192 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Empowerme Rehabilitation Illinois, LLC | Speech-Language Pathologist | Current |
Accepting new patients |
| Empowerme Rehabilitation Illinois, LLC | Speech-Language Pathologist | Current |
Accepting new patients |
| Empowerme Wellness Kansas City, LLC | Speech-Language Pathologist | Current |
Accepting new patients |
Locations
1021 W E St
Belleville, IL 62220
Phone (618) 233-2095
7108 Marine Rd
Edwardsville, IL 62025
Phone (618) 706-9759
1335 Strassner Dr
Saint Louis, MO 63144
Phone (314) 673-6723
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 115840 | MO | Yes |
Addresses
Primary practice location
202 Pawnee Rd
Lake Ozark, MO 65049-4946
Mailing address
54 Hospital Dr
Osage Beach, MO 65065-3050
NPI Registry JSON
{
"created_epoch": "1576022400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1576022400000",
"number": "1396383113",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "54 HOSPITAL DR",
"city": "OSAGE BEACH",
"state": "MO",
"postal_code": "650653050"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "202 PAWNEE RD",
"city": "LAKE OZARK",
"state": "MO",
"postal_code": "650494946",
"telephone_number": "309-255-0517"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CREASY",
"first_name": "ANGELA",
"middle_name": "SUE",
"name_prefix": "Mrs.",
"credential": "SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-12-11",
"last_updated": "2019-12-11",
"certification_date": "2019-12-11",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "MO",
"license": "115840",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Ozark, MO
- Change Academy at Lake of the Ozarks
- Change Academy Lake of the Ozarks
- Change Academy Lake of the Ozarks
- Change Academy Lake Ozark
- Paven Clark
- Colleen Annette Cueni-Smith
- Jean Louise Curtit-Voss
- Annmarie Davis
- Randall Galen Drake
- Mary Ann Duckworth
All providers in Lake Ozark, MO · Speech-Language Pathologist in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 11, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.