{
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"FirstLineMailingAddress": "2867 JAMES AVE S APT 4",
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"MailingAddressCityName": "MINNEAPOLIS",
"MailingAddressStateName": "MN",
"MailingAddressPostalCode": "55408-1890",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "612-202-0535",
"MailingAddressFaxNumber": "612-224-9655",
"FirstLinePracticeLocationAddress": "7101 YORK AVE S STE 145",
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"PracticeLocationAddressCityName": "EDINA",
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"PracticeLocationAddressTelephoneNumber": "612-202-0535",
"PracticeLocationAddressFaxNumber": "763-999-6107",
"EnumerationDate": "04/29/2017",
"LastUpdateDate": "07/05/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LASKI",
"AuthorizedOfficialFirstName": "SANDRA",
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"AuthorizedOfficialCredential": "DSW, M.ED., LICSW, L",
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1041C0700X",
"TaxonomyName": "Clinical Social Worker",
"LicenseNumber": "18622",
"LicenseNumberStateCode": "MN",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}