{
"Npi": {
"NPI": "1215752944",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "RAUK",
"FirstName": "INGRID",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": "PHD",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "150 SIMS DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SYRACUSE",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "13244-1359",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "517-862-8501",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "725 E ADAMS ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SYRACUSE",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "13210-2576",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "315-464-5240",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "11/18/2024",
"LastUpdateDate": "11/18/2024",
"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": "103T00000X",
"TaxonomyName": "Psychologist",
"LicenseNumber": "6301019455",
"LicenseNumberStateCode": "MI",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "103T00000X",
"TaxonomyName": "Psychologist",
"LicenseNumber": "026464",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}