Provider Demographics
NPI:1053430884
Name:OVERTON, MARISA
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:
Last Name:OVERTON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 S WOODS MILL RD STE 37W
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3442
Mailing Address - Country:US
Mailing Address - Phone:314-523-5300
Mailing Address - Fax:
Practice Address - Street 1:226 S WOODS MILL RD STE 37W
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3442
Practice Address - Country:US
Practice Address - Phone:314-523-5300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147.001055231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist