1104943174 NPI number — KERRY J DEVRIES M.A., L.C.P.C.

NPI Number: 1104943174
Health Care Provider/Practitioner: KERRY J DEVRIES M.A., L.C.P.C.

NPI Number : 1104943174 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1104943174",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "DEVRIES",
    "FirstName": "KERRY",
    "MiddleName": "J",
    "NamePrefix": "MS.",
    "NameSuffix": null,
    "Credential": "M.A., L.C.P.C.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "BANGEMAN",
    "OtherFirstName": "KERRY",
    "OtherMiddleName": "DEVRIES",
    "OtherNamePrefix": "MS.",
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "1580 N NORTHWEST HWY STE 125",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PARK RIDGE",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60068-1470",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "224-707-0847",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1580 N NORTHWEST HWY STE 125",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PARK RIDGE",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "60068-1470",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "224-707-0847",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/23/2007",
    "LastUpdateDate": "02/24/2020",
    "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": "101YP2500X",
        "TaxonomyName": "Professional Counselor",
        "LicenseNumber": "180-000829",
        "LicenseNumberStateCode": "IL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}