{
"Npi": {
"NPI": "1164020509",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "JEVMORE",
"FirstName": "RACHEL",
"MiddleName": "J",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "LICSW",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 25608",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SALT LAKE CITY",
"MailingAddressStateName": "UT",
"MailingAddressPostalCode": "84125-0608",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "206-320-4476",
"MailingAddressFaxNumber": "206-568-7043",
"FirstLinePracticeLocationAddress": "1229 MADISON ST STE 750",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SEATTLE",
"PracticeLocationAddressStateName": "WA",
"PracticeLocationAddressPostalCode": "98104-3540",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "206-386-2101",
"PracticeLocationAddressFaxNumber": "206-386-2555",
"EnumerationDate": "10/16/2020",
"LastUpdateDate": "12/31/2020",
"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": "104100000X",
"TaxonomyName": "Social Worker",
"LicenseNumber": "LW61023791",
"LicenseNumberStateCode": "WA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "1041C0700X",
"TaxonomyName": "Clinical Social Worker",
"LicenseNumber": "LW61023791",
"LicenseNumberStateCode": "WA",
"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."
}
}
}
}