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1053013508 NPI number — JAYNE DEANE SPRAFKE LCSW

NPI Number: 1053013508
Health Care Provider/Practitioner: JAYNE DEANE SPRAFKE LCSW

Information about “1053013508” NPI (JAYNE DEANE SPRAFKE LCSW) exists in 1053013508 in HTML format HTML  |  1053013508 in plain Text format TXT  |  1053013508 in PDF (Portable Document Format) PDF  |  1053013508 in an XML format XML  formats.

NPI Number : 1053013508 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1053013508",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "SPRAFKE",
    "FirstName": "JAYNE",
    "MiddleName": "DEANE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LCSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "SHALE",
    "OtherFirstName": "JAYNE",
    "OtherMiddleName": "DEANE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "6502 SUMMIT CV",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "HUNTSVILLE",
    "MailingAddressStateName": "UT",
    "MailingAddressPostalCode": "84317-9411",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "858-531-8080",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "5929 FASHION POINT DR STE 130",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SOUTH OGDEN",
    "PracticeLocationAddressStateName": "UT",
    "PracticeLocationAddressPostalCode": "84403-4683",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "801-781-4257",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/20/2023",
    "LastUpdateDate": "03/20/2023",
    "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": "1041C0700X",
        "TaxonomyName": "Clinical Social Worker",
        "LicenseNumber": "89417193501",
        "LicenseNumberStateCode": "UT",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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