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1376102723 NPI number — JACLYN DANIELLE CALLENDER

NPI Number: 1376102723
Health Care Provider/Practitioner: JACLYN DANIELLE CALLENDER

Information about “1376102723” NPI (JACLYN DANIELLE CALLENDER) exists in 1376102723 in HTML format HTML  |  1376102723 in plain Text format TXT  |  1376102723 in PDF (Portable Document Format) PDF  |  1376102723 in an XML format XML  formats.

NPI Number : 1376102723 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1376102723",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "CALLENDER",
    "FirstName": "JACLYN",
    "MiddleName": "DANIELLE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "ROGGENBUCK",
    "OtherFirstName": "JACLYN",
    "OtherMiddleName": "DANIELLE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "1375 R DALE WERTZ DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BAD AXE",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "48413-1365",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "989-269-9293",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1375 R DALE WERTZ DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BAD AXE",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "48413-1365",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "989-269-9293",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "06/10/2019",
    "LastUpdateDate": "09/23/2021",
    "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": "1041C0700X",
        "TaxonomyName": "Clinical Social Worker",
        "LicenseNumber": "6801111287",
        "LicenseNumberStateCode": "MI",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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