{
"Npi": {
"NPI": "1225672371",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "DAVIS-JACKSON",
"FirstName": "SALLY",
"MiddleName": "ANN",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "MSW, PLMHP, CSW",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 26",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BASSETT",
"MailingAddressStateName": "NE",
"MailingAddressPostalCode": "68714-0026",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "402-684-2908",
"MailingAddressFaxNumber": "402-913-3454",
"FirstLinePracticeLocationAddress": "202 E HIGHWAY 20",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BASSETT",
"PracticeLocationAddressStateName": "NE",
"PracticeLocationAddressPostalCode": "68714-6052",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "402-684-2908",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "11/01/2019",
"LastUpdateDate": "11/01/2019",
"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": "1041C0700X",
"TaxonomyName": "Clinical Social Worker",
"LicenseNumber": "12003",
"LicenseNumberStateCode": "NE",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}