{
"Npi": {
"NPI": "1386969723",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "LUTHERAN SOCIAL SERVICES OF WI & UPPER MI. INC.",
"ParentOrgTIN": null,
"OrgName": "LUTHERAN SOCIAL SERVICES OF WISCONSIN AND UPPER MICHIGAN, INC.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "6737 W WASHINGTON ST STE 2275",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WEST ALLIS",
"MailingAddressStateName": "WI",
"MailingAddressPostalCode": "53214-5666",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "414-246-2300",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "411 N BRIDGE ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CHIPPEWA FALLS",
"PracticeLocationAddressStateName": "WI",
"PracticeLocationAddressPostalCode": "54729-2504",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "833-420-1103",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/29/2010",
"LastUpdateDate": "01/06/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "TREGLOWNE",
"AuthorizedOfficialFirstName": "TARA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "COO",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "414-246-2300",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "101YA0400X",
"TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
"LicenseNumber": "13165",
"LicenseNumberStateCode": "WI",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "101YA0400X",
"TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
"LicenseNumber": "2872",
"LicenseNumberStateCode": "WI",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": [
{
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
},
{
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
]
}
}
}