{
"Npi": {
"NPI": "1104312917",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "WENTWOORD",
"FirstName": "ILKE-VANESSA",
"MiddleName": "MIU-LING",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "LMFT CA #138767",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "611 S PALM CANYON DR STE 7-268",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PALM SPRINGS",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92264-7213",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "760-408-6807",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "611 S PALM CANYON DR STE 7-268",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PALM SPRINGS",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92264-7213",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "760-408-6807",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "07/04/2018",
"LastUpdateDate": "04/10/2023",
"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": "106H00000X",
"TaxonomyName": "Marriage & Family Therapist",
"LicenseNumber": "138767",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "106H00000X",
"TaxonomyName": "Marriage & Family Therapist",
"LicenseNumber": "104199",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}