{
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"FirstLineMailingAddress": "2631 FARNAM ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "DAVENPORT",
"MailingAddressStateName": "IA",
"MailingAddressPostalCode": "52803-1809",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "563-326-4881",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1800 3RD AVE",
"SecondLinePracticeLocationAddress": "SUITE 516",
"PracticeLocationAddressCityName": "ROCK ISLAND",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "61201-8026",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "309-788-1050",
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"EnumerationDate": "04/18/2008",
"LastUpdateDate": "04/18/2008",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DWYER-ELIAS",
"AuthorizedOfficialFirstName": "REBECCA",
"AuthorizedOfficialMiddleName": "RUTH",
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"AuthorizedOfficialNamePrefix": "MS.",
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"AuthorizedOfficialCredential": "LCSW, LISW",
"AuthorizedOfficialTelephoneNumber": "309-788-1050",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "101YM0800X",
"TaxonomyName": "Mental Health Counselor",
"LicenseNumber": null,
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}