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1295107704 NPI number — SUSANNA LEE HARRIS

NPI Number: 1295107704
Health Care Provider/Practitioner: SUSANNA LEE HARRIS

Information about “1295107704” NPI (SUSANNA LEE HARRIS) exists in 1295107704 in HTML format HTML  |  1295107704 in plain Text format TXT  |  1295107704 in PDF (Portable Document Format) PDF  |  1295107704 in an XML format XML  formats.

NPI Number : 1295107704 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1295107704",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "HARRIS",
    "FirstName": "SUSANNA",
    "MiddleName": "LEE",
    "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": "220 ROOSEVELT ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "IRONWOOD",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "49938-1737",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "906-364-7506",
    "MailingAddressFaxNumber": "906-364-7508",
    "FirstLinePracticeLocationAddress": "220 ROOSEVELT ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "IRONWOOD",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "49938",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "906-364-7506",
    "PracticeLocationAddressFaxNumber": "906-364-7508",
    "EnumerationDate": "10/22/2015",
    "LastUpdateDate": "08/05/2020",
    "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": "101YA0400X",
          "TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
          "LicenseNumber": "16301-132",
          "LicenseNumberStateCode": "WI",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YA0400X",
          "TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
          "LicenseNumber": "C-03447",
          "LicenseNumberStateCode": "MI",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1041C0700X",
          "TaxonomyName": "Clinical Social Worker",
          "LicenseNumber": "122960-121",
          "LicenseNumberStateCode": "WI",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1041C0700X",
          "TaxonomyName": "Clinical Social Worker",
          "LicenseNumber": "6801098833",
          "LicenseNumberStateCode": "MI",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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