Active NPI
Marissa Michelle Odens
- Speech-Language Assistant
- West Fargo, ND
National Provider Identifier
1518564848
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Assistant
- License
- 1680
- Practice address
- 207 Main Ave W
West Fargo, ND 58078-1725 - Phone
- (701) 499-1022
- NPI assigned
- Oct 9, 2020
- 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 Assistant | 2355S0801X | 1680 | ND | Primary |
Addresses
Primary practice location
207 Main Ave W
West Fargo, ND 58078-1725
Mailing address
207 Main Ave W
West Fargo, ND 58078-1725
Phone (701) 499-1022
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1680 | ND | MD | Speech-Language Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1602201600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1602201600000",
"number": "1518564848",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "207 MAIN AVE W",
"city": "WEST FARGO",
"state": "ND",
"postal_code": "580781725",
"telephone_number": "701-499-1022"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "207 MAIN AVE W",
"city": "WEST FARGO",
"state": "ND",
"postal_code": "580781725",
"telephone_number": "701-499-1022"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ODENS",
"first_name": "MARISSA",
"middle_name": "MICHELLE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-10-09",
"last_updated": "2020-10-09",
"certification_date": "2020-10-09",
"status": "A"
},
"taxonomies": [
{
"code": "2355S0801X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Speech-Language Assistant",
"state": "ND",
"license": "1680",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Fargo, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.