NPI Code Detail JSON Logo

1104219401 NPI number — LISA MACRI SLP

NPI Number: 1104219401
Health Care Provider/Practitioner: LISA MACRI SLP

Information about “1104219401” NPI (LISA MACRI SLP) exists in 1104219401 in HTML format HTML  |  1104219401 in plain Text format TXT  |  1104219401 in PDF (Portable Document Format) PDF  |  1104219401 in an XML format XML  formats.

NPI Number : 1104219401 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1104219401",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MACRI",
    "FirstName": "LISA",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "SLP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "44050 ASHBURN SHOPPING PLZ",
    "SecondLineMailingAddress": "#195-141",
    "MailingAddressCityName": "ASHBURN",
    "MailingAddressStateName": "VA",
    "MailingAddressPostalCode": "20147-7915",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "571-606-8857",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "44050 ASHBURN SHOPPING PLZ",
    "SecondLinePracticeLocationAddress": "#195-141",
    "PracticeLocationAddressCityName": "ASHBURN",
    "PracticeLocationAddressStateName": "VA",
    "PracticeLocationAddressPostalCode": "20147-7915",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "571-606-8857",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/10/2015",
    "LastUpdateDate": "03/10/2015",
    "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": "2202006113",
        "LicenseNumberStateCode": "VA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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