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1073169553 NPI number — KAYLA PACIC MA

NPI Number: 1073169553
Health Care Provider/Practitioner: KAYLA PACIC MA

Information about “1073169553” NPI (KAYLA PACIC MA) exists in 1073169553 in HTML format HTML  |  1073169553 in plain Text format TXT  |  1073169553 in PDF (Portable Document Format) PDF  |  1073169553 in an XML format XML  formats.

NPI Number : 1073169553 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1073169553",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "PACIC",
    "FirstName": "KAYLA",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MA",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "SCHRAMSKI",
    "OtherFirstName": "KAYLA",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "4341 SUMMERLANE AVE NE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "GRAND RAPIDS",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "49525-9507",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "616-558-6837",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "23100 JEFFERSON AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SAINT CLAIR SHORES",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "48080-2756",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "586-335-2006",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/12/2019",
    "LastUpdateDate": "05/04/2023",
    "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": "101YP2500X",
        "TaxonomyName": "Professional Counselor",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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