{
"Npi": {
"NPI": "1053226571",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "JEPPESEN",
"FirstName": "BAILEE",
"MiddleName": "J",
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "JENSEN",
"OtherFirstName": "BAILEE",
"OtherMiddleName": "J",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "5",
"FirstLineMailingAddress": "280 E LORENE ST APT 16101",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "REXBURG",
"MailingAddressStateName": "ID",
"MailingAddressPostalCode": "83440-1732",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "208-881-6616",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "3715 WOODKING DR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "IDAHO FALLS",
"PracticeLocationAddressStateName": "ID",
"PracticeLocationAddressPostalCode": "83404-4720",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "208-529-2255",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "08/18/2026",
"LastUpdateDate": "08/18/2026",
"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": "235Z00000X",
"TaxonomyName": "Speech-Language Pathologist",
"LicenseNumber": "5281321",
"LicenseNumberStateCode": "ID",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}