Rachel Elizabeth O'Bannon, MS CCC-SLP CBIS

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

2018016956 Issued in MO

Practice address

12380 De Paul Dr
Bridgeton, MO 63044-2511

Phone

(314) 447-9741

NPI assigned

Apr 12, 2020

Last updated

Apr 12, 2020By 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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1586649600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586649600000",
    "number": "1750900585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1570 MAPLEWOOD CT",
            "city": "EDWARDSVILLE",
            "state": "IL",
            "postal_code": "620253186",
            "telephone_number": "618-792-4568"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12380 DE PAUL DR",
            "city": "BRIDGETON",
            "state": "MO",
            "postal_code": "630442511",
            "telephone_number": "314-447-9741"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'BANNON",
        "first_name": "RACHEL",
        "middle_name": "ELIZABETH",
        "credential": "MS CCC-SLP CBIS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-12",
        "last_updated": "2020-04-12",
        "certification_date": "2020-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MO",
            "license": "2018016956",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Speech-Language Pathologist in Bridgeton, MO
• Providers in Bridgeton, 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 12, 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.

Verify at the official NPI Registry.