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1104360890 NPI number — STEPHANIE LEFTWICH-NEEDHAM

NPI Number: 1104360890
Health Care Provider/Practitioner: STEPHANIE LEFTWICH-NEEDHAM

Information about “1104360890” NPI (STEPHANIE LEFTWICH-NEEDHAM) exists in 1104360890 in HTML format HTML  |  1104360890 in plain Text format TXT  |  1104360890 in PDF (Portable Document Format) PDF  |  1104360890 in an XML format XML  formats.

NPI Number : 1104360890 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1104360890",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "LEFTWICH-NEEDHAM",
    "FirstName": "STEPHANIE",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "5455 ALMIRA DR NE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BREMERTON",
    "MailingAddressStateName": "WA",
    "MailingAddressPostalCode": "98311-8330",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "9951 MICKELBERRY RD NW STE 215",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SILVERDALE",
    "PracticeLocationAddressStateName": "WA",
    "PracticeLocationAddressPostalCode": "98383-8309",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "360-900-1319",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "12/14/2016",
    "LastUpdateDate": "07/16/2021",
    "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": "101YM0800X",
          "TaxonomyName": "Mental Health Counselor",
          "LicenseNumber": "61037649",
          "LicenseNumberStateCode": "WA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YM0800X",
          "TaxonomyName": "Mental Health Counselor",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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