1194910521 NPI number — AUTUMN KATHLEEN HASS M.A. CCC-SLP

NPI Number: 1194910521
Health Care Provider/Practitioner: AUTUMN KATHLEEN HASS M.A. CCC-SLP

NPI Number : 1194910521 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1194910521",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "HASS",
    "FirstName": "AUTUMN",
    "MiddleName": "KATHLEEN",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "M.A. CCC-SLP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "HASS-ROBINSON",
    "OtherFirstName": "AUTUMN",
    "OtherMiddleName": "KATHLEEN",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "928 W LEWISTON AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "FERNDALE",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "48220-1285",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "248-496-0905",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "928 W LEWISTON AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FERNDALE",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "48220-1285",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "248-496-0905",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/10/2007",
    "LastUpdateDate": "09/10/2024",
    "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": "7101004905",
        "LicenseNumberStateCode": "MI",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}