{
"Npi": {
"NPI": "1104637768",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "WILLOW THERAPY SERVICES, LLC",
"LastName": null,
"FirstName": null,
"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": "233 S PLEASANT GROVE BLVD STE 201",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PLEASANT GROVE",
"MailingAddressStateName": "UT",
"MailingAddressPostalCode": "84062-2878",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "233 S PLEASANT GROVE BLVD STE 201",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PLEASANT GROVE",
"PracticeLocationAddressStateName": "UT",
"PracticeLocationAddressPostalCode": "84062-2878",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "801-753-8193",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "01/14/2025",
"LastUpdateDate": "01/14/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SCHNEIDER",
"AuthorizedOfficialFirstName": "COURTNEY",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "SPEECH-LANGUAGE PATHOLOGIST/OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MS SLP",
"AuthorizedOfficialTelephoneNumber": "385-277-8685",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "106H00000X",
"TaxonomyName": "Marriage & Family Therapist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "235Z00000X",
"TaxonomyName": "Speech-Language Pathologist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "1041C0700X",
"TaxonomyName": "Clinical Social Worker",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": [
{
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
},
{
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
},
{
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
]
}
}
}