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1194105395 NPI number — HEATHER HAINSTOCK PSY.D.

NPI Number: 1194105395
Health Care Provider/Practitioner: HEATHER HAINSTOCK PSY.D.

Information about “1194105395” NPI (HEATHER HAINSTOCK PSY.D.) exists in 1194105395 in HTML format HTML  |  1194105395 in plain Text format TXT  |  1194105395 in PDF (Portable Document Format) PDF  |  1194105395 in an XML format XML  formats.

NPI Number : 1194105395 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1194105395",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "HAINSTOCK",
    "FirstName": "HEATHER",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PSY.D.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "CASADY",
    "OtherFirstName": "HEATHER",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "PSYD",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "3340 E GOLDSTONE DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MERIDIAN",
    "MailingAddressStateName": "ID",
    "MailingAddressPostalCode": "83642-1026",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "208-367-5170",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1859 S TOPAZ WAY STE 100",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MERIDIAN",
    "PracticeLocationAddressStateName": "ID",
    "PracticeLocationAddressPostalCode": "83642-4401",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "208-209-2432",
    "PracticeLocationAddressFaxNumber": "847-859-5885",
    "EnumerationDate": "06/02/2015",
    "LastUpdateDate": "06/09/2021",
    "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": "101Y00000X",
          "TaxonomyName": "Counselor",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "103TC0700X",
          "TaxonomyName": "Clinical Psychologist",
          "LicenseNumber": "203183",
          "LicenseNumberStateCode": "ID",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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