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1265776298 NPI number — KRISTEN MARIE POLLICH M.A-SLP/CFY

NPI Number: 1265776298
Health Care Provider/Practitioner: KRISTEN MARIE POLLICH M.A-SLP/CFY

Information about “1265776298” NPI (KRISTEN MARIE POLLICH M.A-SLP/CFY) exists in 1265776298 in HTML format HTML  |  1265776298 in plain Text format TXT  |  1265776298 in PDF (Portable Document Format) PDF  |  1265776298 in an XML format XML  formats.

NPI Number : 1265776298 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1265776298",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "POLLICH",
    "FirstName": "KRISTEN",
    "MiddleName": "MARIE",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "M.A-SLP/CFY",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1560 WICKFORD DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "KALAMAZOO",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "49009-7984",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "395 S SHORE DR STE 310",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BATTLE CREEK",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "49014-5466",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "269-660-1025",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "11/15/2012",
    "LastUpdateDate": "11/15/2012",
    "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": "235Z00000X",
        "TaxonomyName": "Speech-Language Pathologist",
        "LicenseNumber": "7101000166",
        "LicenseNumberStateCode": "MI",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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