{
"Npi": {
"NPI": "1043144785",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "NELSON",
"FirstName": "GRACIE",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "2276 E DEVON CT",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GILBERT",
"MailingAddressStateName": "AZ",
"MailingAddressPostalCode": "85296-3929",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "480-234-7173",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2276 E DEVON CT",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "GILBERT",
"PracticeLocationAddressStateName": "AZ",
"PracticeLocationAddressPostalCode": "85296-3929",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "480-710-8500",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "06/09/2026",
"LastUpdateDate": "06/09/2026",
"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": "2355S0801X",
"TaxonomyName": "Speech-Language Assistant",
"LicenseNumber": "SLPA17450",
"LicenseNumberStateCode": "AZ",
"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."
}
}
}
}