Active NPI
Michelle L Obermark, M.S., CCC-SLP/L
- Speech-Language Pathologist
- Saint Louis, MO
National Provider Identifier
1407092067
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 2008020882
- Practice address
- 801 N 11TH St
Medicaid Department
Saint Louis, MO 63101-1015 - Phone
- (314) 345-2535
- NPI assigned
- Dec 31, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 2008020882 | MO | Primary |
Addresses
Primary practice location
801 N 11TH St
Medicaid Department
Saint Louis, MO 63101-1015
Mailing address
6365 Meadowlake Dr
Washington, MO 63090-4131
Phone (314) 402-8499
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2008020882 | MO | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1230681600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1230681600000",
"number": "1407092067",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6365 MEADOWLAKE DR",
"city": "WASHINGTON",
"state": "MO",
"postal_code": "630904131",
"telephone_number": "314-402-8499"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "801 N 11TH ST",
"address_2": "MEDICAID DEPARTMENT",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631011015",
"telephone_number": "314-345-2535"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OBERMARK",
"first_name": "MICHELLE",
"middle_name": "L",
"name_prefix": "Miss",
"credential": "M.S., CCC-SLP/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-12-31",
"last_updated": "2008-12-31",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "MO",
"license": "2008020882",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.