Provider Demographics
NPI:1386529055
Name:HELLEBUSCH, HEIDI ROSE (RDN)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:ROSE
Last Name:HELLEBUSCH
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:ROSE
Other - Last Name:OBERMARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:128 JANEY LN
Mailing Address - Street 2:
Mailing Address - City:PACIFIC
Mailing Address - State:MO
Mailing Address - Zip Code:63069-1241
Mailing Address - Country:US
Mailing Address - Phone:636-432-2494
Mailing Address - Fax:
Practice Address - Street 1:1020 N MASON RD STE 200
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6300
Practice Address - Country:US
Practice Address - Phone:314-996-3140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-11
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2025031654133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered