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1376307066 NPI number — MATTHEW ERICH WOHLGEMUTH LSW

NPI Number: 1376307066
Health Care Provider/Practitioner: MATTHEW ERICH WOHLGEMUTH LSW

Information about “1376307066” NPI (MATTHEW ERICH WOHLGEMUTH LSW) exists in 1376307066 in HTML format HTML  |  1376307066 in plain Text format TXT  |  1376307066 in PDF (Portable Document Format) PDF  |  1376307066 in an XML format XML  formats.

NPI Number : 1376307066 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1376307066",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WOHLGEMUTH",
    "FirstName": "MATTHEW",
    "MiddleName": "ERICH",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "217 COLLEGE DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MOUNT PROSPECT",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60056-3243",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "847-691-8792",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "778 W FRONTAGE RD STE 104",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "NORTHFIELD",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "60093-1209",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "847-291-0700",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "02/12/2024",
    "LastUpdateDate": "02/13/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "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": "150.106608",
        "LicenseNumberStateCode": "IL",
        "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."
      }
    }
  }
}
                
            

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