{
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"FirstLineMailingAddress": "14417 OSAGE ST NW",
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"MailingAddressCityName": "ANDOVER",
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"FirstLinePracticeLocationAddress": "1303 S FRONTAGE RD STE 104",
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"PracticeLocationAddressCityName": "HASTINGS",
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"PracticeLocationAddressCountryCode": "US",
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"EnumerationDate": "03/18/2026",
"LastUpdateDate": "03/18/2026",
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"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "106H00000X",
"TaxonomyName": "Marriage & Family Therapist",
"LicenseNumber": null,
"LicenseNumberStateCode": "MN",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}