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1093022345 NPI number — JAY VANDENBOGAARD M.S., NCC, CADC III

NPI Number: 1093022345
Health Care Provider/Practitioner: JAY VANDENBOGAARD M.S., NCC, CADC III

Information about “1093022345” NPI (JAY VANDENBOGAARD M.S., NCC, CADC III) exists in 1093022345 in HTML format HTML  |  1093022345 in plain Text format TXT  |  1093022345 in PDF (Portable Document Format) PDF  |  1093022345 in an XML format XML  formats.

NPI Number : 1093022345 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1093022345",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "VANDENBOGAARD",
    "FirstName": "JAY",
    "MiddleName": null,
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "M.S., NCC, CADC III",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "ARZADON",
    "OtherFirstName": "JAY",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "2225 PACIFIC BOULEVARD SE",
    "SecondLineMailingAddress": "SUITE 207",
    "MailingAddressCityName": "ALBANY",
    "MailingAddressStateName": "OR",
    "MailingAddressPostalCode": "97321",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "541-704-0762",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2225 PACIFIC BOULEVARD SE",
    "SecondLinePracticeLocationAddress": "SUITE 207",
    "PracticeLocationAddressCityName": "ALBANY",
    "PracticeLocationAddressStateName": "OR",
    "PracticeLocationAddressPostalCode": "97321",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "541-704-0762",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/08/2010",
    "LastUpdateDate": "09/08/2010",
    "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": "101Y00000X",
          "TaxonomyName": "Counselor",
          "LicenseNumber": "R1427",
          "LicenseNumberStateCode": "OR",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YA0400X",
          "TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
          "LicenseNumber": "07-12-61",
          "LicenseNumberStateCode": "OR",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "101YM0800X",
          "TaxonomyName": "Mental Health Counselor",
          "LicenseNumber": "R1427",
          "LicenseNumberStateCode": "OR",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YP2500X",
          "TaxonomyName": "Professional Counselor",
          "LicenseNumber": "R1427",
          "LicenseNumberStateCode": "OR",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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