{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "STEPHANIE CORNETTE P.C.",
"LastName": null,
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"NamePrefix": null,
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"FirstLineMailingAddress": "4055 W PETERSON AVE",
"SecondLineMailingAddress": "201",
"MailingAddressCityName": "CHICAGO",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60646-6182",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "773-988-7144",
"MailingAddressFaxNumber": "773-423-4300",
"FirstLinePracticeLocationAddress": "4055 W PETERSON AVE",
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"PracticeLocationAddressCityName": "CHICAGO",
"PracticeLocationAddressStateName": "IL",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "773-988-7144",
"PracticeLocationAddressFaxNumber": "773-423-4300",
"EnumerationDate": "06/10/2009",
"LastUpdateDate": "06/10/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CORNETTE",
"AuthorizedOfficialFirstName": "STEPHANIE",
"AuthorizedOfficialMiddleName": "L",
"AuthorizedOfficialTitle": "CLINICAL PSYCHOLOGIST",
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"AuthorizedOfficialCredential": "PSY.D.",
"AuthorizedOfficialTelephoneNumber": "773-988-7144",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QM0801X",
"TaxonomyName": "Mental Health Clinic/Center (Including Community Mental Health Center)",
"LicenseNumber": "071007251",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
},
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}
}