1003964537 NPI number — EMILY ESTES M.ED., CCC/SLP

NPI Number: 1003964537
Health Care Provider/Practitioner: EMILY ESTES M.ED., CCC/SLP

NPI Number : 1003964537 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1003964537",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "ESTES",
    "FirstName": "EMILY",
    "MiddleName": null,
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "M.ED., CCC/SLP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 412307",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BOSTON",
    "MailingAddressStateName": "MA",
    "MailingAddressPostalCode": "02241-8215",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "914-294-4050",
    "MailingAddressFaxNumber": "631-760-8306",
    "FirstLinePracticeLocationAddress": "1622 TIMBERWOOD BLVD STE AND211",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CHARLOTTESVILLE",
    "PracticeLocationAddressStateName": "VA",
    "PracticeLocationAddressPostalCode": "22911-7573",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "434-202-2830",
    "PracticeLocationAddressFaxNumber": "434-529-8457",
    "EnumerationDate": "01/08/2007",
    "LastUpdateDate": "07/01/2021",
    "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": "235Z00000X",
          "TaxonomyName": "Speech-Language Pathologist",
          "LicenseNumber": "5843",
          "LicenseNumberStateCode": "NC",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "235Z00000X",
          "TaxonomyName": "Speech-Language Pathologist",
          "LicenseNumber": "2202005330",
          "LicenseNumberStateCode": "VA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}