NPI Code Detail JSON Logo

1326812488 NPI number — ATHENA LEEANN WILDENBORG T-23-2498

NPI Number: 1326812488
Health Care Provider/Practitioner: ATHENA LEEANN WILDENBORG T-23-2498

Information about “1326812488” NPI (ATHENA LEEANN WILDENBORG T-23-2498) exists in 1326812488 in HTML format HTML  |  1326812488 in plain Text format TXT  |  1326812488 in PDF (Portable Document Format) PDF  |  1326812488 in an XML format XML  formats.

NPI Number : 1326812488 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1326812488",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WILDENBORG",
    "FirstName": "ATHENA",
    "MiddleName": "LEEANN",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "T-23-2498",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1122 NE 122ND AVE STE A102",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PORTLAND",
    "MailingAddressStateName": "OR",
    "MailingAddressPostalCode": "97230-2082",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "503-954-1890",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "200 LA LOMA CT",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ROSEVILLE",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "95678-2908",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "360-214-4102",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "11/09/2023",
    "LastUpdateDate": "11/09/2023",
    "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": "101Y00000X",
        "TaxonomyName": "Counselor",
        "LicenseNumber": "T-23-2498",
        "LicenseNumberStateCode": "OR",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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