NPI Code Detail JSON Logo

1215684485 NPI number — CRYSTAL MARIE RIDDLE-ANDERSON NA-C, P-TA, SUD, CPC

NPI Number: 1215684485
Health Care Provider/Practitioner: CRYSTAL MARIE RIDDLE-ANDERSON NA-C, P-TA, SUD, CPC

Information about “1215684485” NPI (CRYSTAL MARIE RIDDLE-ANDERSON NA-C, P-TA, SUD, CPC) exists in 1215684485 in HTML format HTML  |  1215684485 in plain Text format TXT  |  1215684485 in PDF (Portable Document Format) PDF  |  1215684485 in an XML format XML  formats.

NPI Number : 1215684485 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1215684485",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "RIDDLE-ANDERSON",
    "FirstName": "CRYSTAL",
    "MiddleName": "MARIE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "NA-C, P-TA, SUD, CPC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "RIDDLE",
    "OtherFirstName": "CRYSTAL",
    "OtherMiddleName": "M",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "NA-C, PT-A, CPC,SUD",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "1348 SUNRISE HILL LN # A",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "NEWPORT",
    "MailingAddressStateName": "WA",
    "MailingAddressPostalCode": "99156-8788",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "509-906-3471",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1348 SUNRISE HILL LN",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "NEWPORT",
    "PracticeLocationAddressStateName": "WA",
    "PracticeLocationAddressPostalCode": "99156-8788",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "208-217-1079",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/07/2022",
    "LastUpdateDate": "03/07/2022",
    "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": "101YA0400X",
          "TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "104100000X",
          "TaxonomyName": "Social Worker",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "175T00000X",
          "TaxonomyName": "Peer Specialist",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "225200000X",
          "TaxonomyName": "Physical Therapy Assistant",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "376K00000X",
          "TaxonomyName": "Nurse's Aide",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "106S00000X",
          "TaxonomyName": "Behavior Technician",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": [
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        }
      ]
    }
  }
}
                
            

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