NPI Code Detail JSON Logo

1386311165 NPI number — ASHLEY MERCEDES HEIDTMANN M.S. CCC-SLP

NPI Number: 1386311165
Health Care Provider/Practitioner: ASHLEY MERCEDES HEIDTMANN M.S. CCC-SLP

Information about “1386311165” NPI (ASHLEY MERCEDES HEIDTMANN M.S. CCC-SLP) exists in 1386311165 in HTML format HTML  |  1386311165 in plain Text format TXT  |  1386311165 in PDF (Portable Document Format) PDF  |  1386311165 in an XML format XML  formats.

NPI Number : 1386311165 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1386311165",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "HEIDTMANN",
    "FirstName": "ASHLEY",
    "MiddleName": "MERCEDES",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "M.S. CCC-SLP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "3515 W MEDILL AVE APT 2W",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CHICAGO",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60647-6168",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "203-988-7336",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2520 ELISHA AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ZION",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "60099-2676",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "847-872-6050",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/27/2021",
    "LastUpdateDate": "01/12/2023",
    "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": "235Z00000X",
          "TaxonomyName": "Speech-Language Pathologist",
          "LicenseNumber": "5772",
          "LicenseNumberStateCode": "OK",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "235Z00000X",
          "TaxonomyName": "Speech-Language Pathologist",
          "LicenseNumber": "242.006368",
          "LicenseNumberStateCode": "IL",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "235Z00000X",
          "TaxonomyName": "Speech-Language Pathologist",
          "LicenseNumber": "22008086A",
          "LicenseNumberStateCode": "IN",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "235Z00000X",
          "TaxonomyName": "Speech-Language Pathologist",
          "LicenseNumber": "7101007912",
          "LicenseNumberStateCode": "MI",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "235Z00000X",
          "TaxonomyName": "Speech-Language Pathologist",
          "LicenseNumber": "113958",
          "LicenseNumberStateCode": "IA",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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