{
"Npi": {
"NPI": "1366927147",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "HOPE SPEECH PATHOLOGY PLLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"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": "3075 SOUTHWESTERN BLVD",
"SecondLineMailingAddress": "STE 204",
"MailingAddressCityName": "ORCHARD PARK",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "14127-1236",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "716-608-3366",
"MailingAddressFaxNumber": "716-322-2566",
"FirstLinePracticeLocationAddress": "3075 SOUTHWESTERN BLVD",
"SecondLinePracticeLocationAddress": "STE 204",
"PracticeLocationAddressCityName": "ORCHARD PARK",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "14127-1236",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "716-608-3366",
"PracticeLocationAddressFaxNumber": "716-322-2566",
"EnumerationDate": "09/27/2018",
"LastUpdateDate": "02/03/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SUMBRUM",
"AuthorizedOfficialFirstName": "AMY",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER& CERTIFIED SPEECH LANGUAGE PA",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "CCC-SLP",
"AuthorizedOfficialTelephoneNumber": "716-608-3366",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "235Z00000X",
"TaxonomyName": "Speech-Language Pathologist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}