1073925350 NPI number — PANDORA KAY PALMER L.C.P.C., C.R.C

NPI Number: 1073925350
Health Care Provider/Practitioner: PANDORA KAY PALMER L.C.P.C., C.R.C

NPI Number : 1073925350 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1073925350",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "PALMER",
    "FirstName": "PANDORA",
    "MiddleName": "KAY",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "L.C.P.C., C.R.C",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "ZIOKOWSKI",
    "OtherFirstName": "PANDORA",
    "OtherMiddleName": "KAY",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "L.C.P.C,, C.R.C",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "3720 HAYDEN DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BILLINGS",
    "MailingAddressStateName": "MT",
    "MailingAddressPostalCode": "59102-1129",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "406-698-0020",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "615 N 19TH ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BILLINGS",
    "PracticeLocationAddressStateName": "MT",
    "PracticeLocationAddressPostalCode": "59101-1426",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "406-698-1587",
    "PracticeLocationAddressFaxNumber": "406-656-0935",
    "EnumerationDate": "05/21/2014",
    "LastUpdateDate": "09/10/2014",
    "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": "SWP-LCPC-LIC-7854",
          "LicenseNumberStateCode": "MT",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "225C00000X",
          "TaxonomyName": "Rehabilitation Counselor",
          "LicenseNumber": "00111462",
          "LicenseNumberStateCode": "MT",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}