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1083059315 NPI number — AMY LEE DEICHERT MS-SP-CCC

NPI Number: 1083059315
Health Care Provider/Practitioner: AMY LEE DEICHERT MS-SP-CCC

Information about “1083059315” NPI (AMY LEE DEICHERT MS-SP-CCC) exists in 1083059315 in HTML format HTML  |  1083059315 in plain Text format TXT  |  1083059315 in PDF (Portable Document Format) PDF  |  1083059315 in an XML format XML  formats.

NPI Number : 1083059315 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1083059315",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "DEICHERT",
    "FirstName": "AMY",
    "MiddleName": "LEE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MS-SP-CCC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "6318 FALBRIDGE CT",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "JACKSONVILLE",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "32258-9435",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "904-318-3159",
    "MailingAddressFaxNumber": "904-396-2520",
    "FirstLinePracticeLocationAddress": "3627 UNIVERSITY BLVD S",
    "SecondLinePracticeLocationAddress": "SUITE 210",
    "PracticeLocationAddressCityName": "JACKSONVILLE",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "32216-4230",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "904-399-5311",
    "PracticeLocationAddressFaxNumber": "904-396-2520",
    "EnumerationDate": "04/30/2013",
    "LastUpdateDate": "09/01/2016",
    "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": "SA 574",
        "LicenseNumberStateCode": "FL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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