{
"Npi": {
"NPI": "1104264530",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "VIBBARD",
"FirstName": "ALYSSA",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": "LISW",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "PFANTZ",
"OtherFirstName": "ALYSSA",
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "1900 SILVER LAKE RD NW STE 110",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "NEW BRIGHTON",
"MailingAddressStateName": "MN",
"MailingAddressPostalCode": "55112-1789",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "651-628-9566",
"MailingAddressFaxNumber": "651-628-0411",
"FirstLinePracticeLocationAddress": "1105 N ANKENY BLVD STE 100",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ANKENY",
"PracticeLocationAddressStateName": "IA",
"PracticeLocationAddressPostalCode": "50023-4003",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "515-255-8399",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "06/07/2013",
"LastUpdateDate": "12/31/2024",
"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": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "101YM0800X",
"TaxonomyName": "Mental Health Counselor",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "1041C0700X",
"TaxonomyName": "Clinical Social Worker",
"LicenseNumber": "087466",
"LicenseNumberStateCode": "IA",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}