{
"Npi": {
"NPI": "1205119575",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "PACK",
"FirstName": "JESSICA",
"MiddleName": "K.",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "MHA, MS, LGC",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 3139",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CORYDON",
"MailingAddressStateName": "IN",
"MailingAddressPostalCode": "47112-3139",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "888-252-2842",
"MailingAddressFaxNumber": "502-470-3645",
"FirstLinePracticeLocationAddress": "4330 GLENVIEW AVENUE",
"SecondLinePracticeLocationAddress": "#111",
"PracticeLocationAddressCityName": "GLENVIEW",
"PracticeLocationAddressStateName": "KY",
"PracticeLocationAddressPostalCode": "40025-0111",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "888-252-2842",
"PracticeLocationAddressFaxNumber": "502-470-3645",
"EnumerationDate": "09/23/2011",
"LastUpdateDate": "04/24/2018",
"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": "170300000X",
"TaxonomyName": "Genetic Counselor (M.S.)",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}