1215153713 NPI number — SARAH SHEA COLLINSWORTH M.ED, CCC-SLP

NPI Number: 1215153713
Health Care Provider/Practitioner: SARAH SHEA COLLINSWORTH M.ED, CCC-SLP

NPI Number : 1215153713 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1215153713",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "COLLINSWORTH",
    "FirstName": "SARAH",
    "MiddleName": "SHEA",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "M.ED, CCC-SLP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "LAYTON",
    "OtherFirstName": "SARAH",
    "OtherMiddleName": "SHEA",
    "OtherNamePrefix": "MRS.",
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "175 CR 754",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "JONESBORO",
    "MailingAddressStateName": "AR",
    "MailingAddressPostalCode": "72401",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "870-275-5199",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "262 SOUTHWEST DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "JONESBORO",
    "PracticeLocationAddressStateName": "AR",
    "PracticeLocationAddressPostalCode": "72401",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "870-275-5199",
    "PracticeLocationAddressFaxNumber": "870-931-4457",
    "EnumerationDate": "04/17/2007",
    "LastUpdateDate": "11/18/2016",
    "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": "SP#P8026",
          "LicenseNumberStateCode": "AR",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "235Z00000X",
          "TaxonomyName": "Speech-Language Pathologist",
          "LicenseNumber": "SP#2572",
          "LicenseNumberStateCode": "AR",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}