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1396607628 NPI number — SOPHIA LOUISE EKNESS

NPI Number: 1396607628
Health Care Provider/Practitioner: SOPHIA LOUISE EKNESS

Information about “1396607628” NPI (SOPHIA LOUISE EKNESS) exists in 1396607628 in HTML format HTML  |  1396607628 in plain Text format TXT  |  1396607628 in PDF (Portable Document Format) PDF  |  1396607628 in an XML format XML  formats.

NPI Number : 1396607628 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1396607628",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "EKNESS",
    "FirstName": "SOPHIA",
    "MiddleName": "LOUISE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "303 1ST AVE NE STE 365",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "FARIBAULT",
    "MailingAddressStateName": "MN",
    "MailingAddressPostalCode": "55021-5297",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "507-225-0292",
    "MailingAddressFaxNumber": "612-444-3292",
    "FirstLinePracticeLocationAddress": "303 1ST AVE NE STE 365",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FARIBAULT",
    "PracticeLocationAddressStateName": "MN",
    "PracticeLocationAddressPostalCode": "55021-5297",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "507-225-0292",
    "PracticeLocationAddressFaxNumber": "612-444-3292",
    "EnumerationDate": "11/25/2025",
    "LastUpdateDate": "11/25/2025",
    "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": "101YA0400X",
        "TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
        "LicenseNumber": "307394",
        "LicenseNumberStateCode": "MN",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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