NPI Code Detail JSON Logo

1396621447 NPI number — KENIA HEREDIA

NPI Number: 1396621447
Health Care Provider/Practitioner: KENIA HEREDIA

Information about “1396621447” NPI (KENIA HEREDIA) exists in 1396621447 in HTML format HTML  |  1396621447 in plain Text format TXT  |  1396621447 in PDF (Portable Document Format) PDF  |  1396621447 in an XML format XML  formats.

NPI Number : 1396621447 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1396621447",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "HEREDIA",
    "FirstName": "KENIA",
    "MiddleName": null,
    "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": "1419 WILLIAMS AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ROUND LAKE BEACH",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60073-2237",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "847-704-0394",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1 E ERIE ST STE 525-2211",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CHICAGO",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "60611-2740",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "773-349-2111",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/14/2025",
    "LastUpdateDate": "08/14/2025",
    "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": "101YM0800X",
        "TaxonomyName": "Mental Health Counselor",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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