{
"Npi": {
"NPI": "1376135962",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "DEMENT",
"FirstName": "KATIE",
"MiddleName": "ANN",
"NamePrefix": "MS.",
"NameSuffix": null,
"Credential": "LPC",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "9862A FOLKERS DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FRANKFORT",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60423-1100",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "815-651-9497",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "17255 OAK PARK AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "TINLEY PARK",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "60477-3401",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "708-633-4533",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "02/05/2021",
"LastUpdateDate": "06/28/2024",
"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": "101YP2500X",
"TaxonomyName": "Professional Counselor",
"LicenseNumber": "180.016211",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "101YP2500X",
"TaxonomyName": "Professional Counselor",
"LicenseNumber": "178.015720",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}