Lisa L Bloodworth

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

0483029 Issued in MO

Practice address

12555 Partridge Run Dr
Florissant, MO 63033-5015

Phone

(314) 953-7600

NPI assigned

Apr 13, 2018

Last updated

Apr 13, 2018By the provider in NPPES

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 1

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• 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": "1437646619",
    "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": "BLOODWORTH",
        "first_name": "LISA",
        "middle_name": "L",
        "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": "0483029",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "465926707",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mary Blaylock
• Yolanda Bledsoe, MD
• Blessing Consumer Directed Services LLC
• Blest Adult Day Care LLC
• Blissful Harmony Home Care Inc
• Akyenaa K Boadi, LPC
• Boain Dental Care
• Jennifer Boain, D.D.S.
• John Christopher Boain, D.D.S.
• Mary Ellen Boedeker

• 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.