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1306554076 NPI number — MARGARET ELYSE SULFRIDGE BCBA, COBA

NPI Number: 1306554076
Health Care Provider/Practitioner: MARGARET ELYSE SULFRIDGE BCBA, COBA

Information about “1306554076” NPI (MARGARET ELYSE SULFRIDGE BCBA, COBA) exists in 1306554076 in HTML format HTML  |  1306554076 in plain Text format TXT  |  1306554076 in PDF (Portable Document Format) PDF  |  1306554076 in an XML format XML  formats.

NPI Number : 1306554076 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1306554076",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "SULFRIDGE",
    "FirstName": "MARGARET",
    "MiddleName": "ELYSE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "BCBA, COBA",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "SULFRIDGE",
    "OtherFirstName": "MARGARET",
    "OtherMiddleName": "ELYSE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "BCBA",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "PO BOX 28",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CECIL",
    "MailingAddressStateName": "OH",
    "MailingAddressPostalCode": "45821-0028",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "4935 HILLEGAS RD STE 200",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FORT WAYNE",
    "PracticeLocationAddressStateName": "IN",
    "PracticeLocationAddressPostalCode": "46818-1943",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "260-338-1241",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "11/10/2022",
    "LastUpdateDate": "04/17/2025",
    "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": "103K00000X",
        "TaxonomyName": "Behavior Analyst",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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