Laura Jean Bode, RT(T),CMD,B.S.

Primary specialty

Radiation Therapy Radiologic TechnologistTaxonomy code 2471R0002X

Practice address

4921 Park View Place
St Louis, MO 63110

Phone

(618) 210-1179

NPI assigned

Nov 16, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Ms. Laura Jean Fortman Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Bachelor of Science

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

{
    "created_epoch": "1195171200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1195171200000",
    "number": "1548441652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3610 FOSSIL CREEK LN",
            "city": "WATERLOO",
            "state": "IL",
            "postal_code": "622984650",
            "telephone_number": "618-210-1179"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4921 PARK VIEW PLACE",
            "city": "ST LOUIS",
            "state": "MO",
            "postal_code": "63110",
            "telephone_number": "618-210-1179"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BODE",
        "first_name": "LAURA",
        "middle_name": "JEAN",
        "name_prefix": "Mrs.",
        "credential": "RT(T),CMD,B.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-11-16",
        "last_updated": "2007-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2471R0002X",
            "taxonomy_group": "",
            "desc": "Radiologic Technologist, Radiation Therapy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "247200000X",
            "taxonomy_group": "",
            "desc": "Technician, Other",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LAURA",
            "last_name": "FORTMAN",
            "middle_name": "JEAN",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kathleen Louise Bockhold, CCC-SLP
• Brittany Bockhorst
• Alexis Bockting
• Payton Bodden, PA-C
• Bobbie Bode, FNP-C
• Cecilia Bodet, MA, LPC
• Timothy Eugene Bodey Sr., DDS
• Aakash Bodhit, M.D.
• Nicholas Joseph Bodi, FNP
• Jacquelyne Bodley

• Radiologic Technologist in St Louis, MO
• Providers in St Louis, MO by specialty
• Radiologic Technologist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2007; 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.