{
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"IsOrgSubpart": "N",
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"LastName": null,
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"NamePrefix": null,
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"FirstLineMailingAddress": "3860 W 95TH ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "EVERGREEN PARK",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60805-2034",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "708-422-3500",
"MailingAddressFaxNumber": "708-422-3989",
"FirstLinePracticeLocationAddress": "3860 W 95TH ST",
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"PracticeLocationAddressCityName": "EVERGREEN PARK",
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"PracticeLocationAddressTelephoneNumber": "708-422-3500",
"PracticeLocationAddressFaxNumber": "708-422-3989",
"EnumerationDate": "07/30/2007",
"LastUpdateDate": "07/01/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MONEKA",
"AuthorizedOfficialFirstName": "WYNNETTE",
"AuthorizedOfficialMiddleName": "J.",
"AuthorizedOfficialTitle": "PRESIDENT/AUDIOLOGIST",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.A. CCC/A",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Audiologist",
"LicenseNumber": "147000328",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}