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1225455975 NPI number — JESSICA EVANS CCC-SLP INC.

NPI Number: 1225455975
Health Care Provider/Practitioner: JESSICA EVANS CCC-SLP INC.

Information about “1225455975” NPI (JESSICA EVANS CCC-SLP INC.) exists in 1225455975 in HTML format HTML  |  1225455975 in plain Text format TXT  |  1225455975 in PDF (Portable Document Format) PDF  |  1225455975 in an XML format XML  formats.

NPI Number : 1225455975 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1225455975",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "JESSICA EVANS CCC-SLP INC.",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1725 BOSTON ST SE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "GRAND RAPIDS",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "49506-4461",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "786-877-5679",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1725 BOSTON ST SE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "GRAND RAPIDS",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "49506-4461",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "786-877-5679",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/19/2014",
    "LastUpdateDate": "03/19/2014",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "EVANS",
    "AuthorizedOfficialFirstName": "JESSICA",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "PRESIDENT",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "786-877-5679",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "235Z00000X",
        "TaxonomyName": "Speech-Language Pathologist",
        "LicenseNumber": "7101000969",
        "LicenseNumberStateCode": "MI",
        "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."
      }
    }
  }
}
                
            

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