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1144474172 NPI number — BROOKE L MEDLIN M.S. CCC-SLP

NPI Number: 1144474172
Health Care Provider/Practitioner: BROOKE L MEDLIN M.S. CCC-SLP

Information about “1144474172” NPI (BROOKE L MEDLIN M.S. CCC-SLP) exists in 1144474172 in HTML format HTML  |  1144474172 in plain Text format TXT  |  1144474172 in PDF (Portable Document Format) PDF  |  1144474172 in an XML format XML  formats.

NPI Number : 1144474172 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1144474172",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MEDLIN",
    "FirstName": "BROOKE",
    "MiddleName": "L",
    "NamePrefix": "MS.",
    "NameSuffix": null,
    "Credential": "M.S. CCC-SLP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "519 BOHLEBER DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CARMI",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "62821-1501",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "618-382-8084",
    "MailingAddressFaxNumber": "618-643-5304",
    "FirstLinePracticeLocationAddress": "519 BOHLEBER DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CARMI",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "62821-1501",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "618-382-8084",
    "PracticeLocationAddressFaxNumber": "618-643-5304",
    "EnumerationDate": "11/04/2008",
    "LastUpdateDate": "11/04/2008",
    "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": "235Z00000X",
        "TaxonomyName": "Speech-Language Pathologist",
        "LicenseNumber": "242.000784",
        "LicenseNumberStateCode": "IL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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