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1376352658 NPI number — JILL VARADY GRANOFF PHD

NPI Number: 1376352658
Health Care Provider/Practitioner: JILL VARADY GRANOFF PHD

Information about “1376352658” NPI (JILL VARADY GRANOFF PHD) exists in 1376352658 in HTML format HTML  |  1376352658 in plain Text format TXT  |  1376352658 in PDF (Portable Document Format) PDF  |  1376352658 in an XML format XML  formats.

NPI Number : 1376352658 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1376352658",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GRANOFF",
    "FirstName": "JILL",
    "MiddleName": "VARADY",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "PHD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "REAVIS",
    "OtherFirstName": "JILL",
    "OtherMiddleName": "VARADY",
    "OtherNamePrefix": "MS.",
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "150 N ASHLAND AVE UNIT 214",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CHICAGO",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60607-5222",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "312-841-0593",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "5000 S 5TH AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "HINES",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "60141-3030",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "708-202-8397",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/02/2025",
    "LastUpdateDate": "01/02/2025",
    "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": "103TC0700X",
        "TaxonomyName": "Clinical Psychologist",
        "LicenseNumber": "5301-57",
        "LicenseNumberStateCode": "WI",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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