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1003052572 NPI number — JESSICA MARIE GUTIERREZ LCSW, CSAC, ICS

NPI Number: 1003052572
Health Care Provider/Practitioner: JESSICA MARIE GUTIERREZ LCSW, CSAC, ICS

Information about “1003052572” NPI (JESSICA MARIE GUTIERREZ LCSW, CSAC, ICS) exists in 1003052572 in HTML format HTML  |  1003052572 in plain Text format TXT  |  1003052572 in PDF (Portable Document Format) PDF  |  1003052572 in an XML format XML  formats.

NPI Number : 1003052572 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1003052572",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GUTIERREZ",
    "FirstName": "JESSICA",
    "MiddleName": "MARIE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LCSW, CSAC, ICS",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "GUTIERREZ",
    "OtherFirstName": "JESSICA",
    "OtherMiddleName": "MARIE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "PANKRATZ",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "100 RIVER PL STE 260",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MONONA",
    "MailingAddressStateName": "WI",
    "MailingAddressPostalCode": "53716-4043",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "608-466-6560",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2101 LINDEN AVE APT 2",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MADISON",
    "PracticeLocationAddressStateName": "WI",
    "PracticeLocationAddressPostalCode": "53704-5350",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "608-466-6560",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/05/2009",
    "LastUpdateDate": "02/14/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "101YA0400X",
          "TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
          "LicenseNumber": "15584-132",
          "LicenseNumberStateCode": "WI",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1041C0700X",
          "TaxonomyName": "Clinical Social Worker",
          "LicenseNumber": "7533-123",
          "LicenseNumberStateCode": "WI",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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