1255754560 NPI number — JUDITH KROOVAND MASTERS IN SPEECH/LA

NPI Number: 1255754560
Health Care Provider/Practitioner: JUDITH KROOVAND MASTERS IN SPEECH/LA

NPI Number : 1255754560 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1255754560",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "KROOVAND",
    "FirstName": "JUDITH",
    "MiddleName": null,
    "NamePrefix": "MS.",
    "NameSuffix": null,
    "Credential": "MASTERS IN SPEECH/LA",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "12 CHIPPEWAY CT",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PALM COAST",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "32137-8934",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "386-445-1150",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "4875 PALM COAST PKWY NW",
    "SecondLinePracticeLocationAddress": "SUITE 2",
    "PracticeLocationAddressCityName": "PALM COAST",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "32137-3670",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "386-446-9935",
    "PracticeLocationAddressFaxNumber": "386-446-7777",
    "EnumerationDate": "01/23/2014",
    "LastUpdateDate": "01/11/2016",
    "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": "2355S0801X",
          "TaxonomyName": "Speech-Language Assistant",
          "LicenseNumber": "SI2726",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "235Z00000X",
          "TaxonomyName": "Speech-Language Pathologist",
          "LicenseNumber": "SZ 6536",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}