1336416635 NPI number — KRISTEN L VESBACH MS, LPC, ATR-L

NPI Number: 1336416635
Health Care Provider/Practitioner: KRISTEN L VESBACH MS, LPC, ATR-L

NPI Number : 1336416635 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1336416635",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "VESBACH",
    "FirstName": "KRISTEN",
    "MiddleName": "L",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MS, LPC, ATR-L",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "6692 FAIRWAY CIR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WINDSOR",
    "MailingAddressStateName": "WI",
    "MailingAddressPostalCode": "53598-9740",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2976 TRIVERTON PIKE DR",
    "SecondLinePracticeLocationAddress": "SUITE 119",
    "PracticeLocationAddressCityName": "FITCHBURG",
    "PracticeLocationAddressStateName": "WI",
    "PracticeLocationAddressPostalCode": "53711-5840",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "262-719-6569",
    "PracticeLocationAddressFaxNumber": "608-286-1088",
    "EnumerationDate": "11/30/2011",
    "LastUpdateDate": "12/01/2015",
    "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": "101YM0800X",
          "TaxonomyName": "Mental Health Counselor",
          "LicenseNumber": "97-36",
          "LicenseNumberStateCode": "WI",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YP2500X",
          "TaxonomyName": "Professional Counselor",
          "LicenseNumber": "5219-125",
          "LicenseNumberStateCode": "WI",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}