{
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "TMS TASHA MARTIN-STANFORD SPEECH THERAPY SERVICES LLC",
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"FirstName": null,
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"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"FirstLineMailingAddress": "4820 QUEEN RIDGE AVE",
"SecondLineMailingAddress": "#732",
"MailingAddressCityName": "KANSAS CITY",
"MailingAddressStateName": "MO",
"MailingAddressPostalCode": "64136-1423",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "816-373-4841",
"MailingAddressFaxNumber": "816-373-4841",
"FirstLinePracticeLocationAddress": "4820 QUEEN RIDGE AVE",
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"PracticeLocationAddressStateName": "MO",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "816-373-4841",
"PracticeLocationAddressFaxNumber": "816-373-4841",
"EnumerationDate": "01/26/2012",
"LastUpdateDate": "01/26/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MARTIN-STANFORD",
"AuthorizedOfficialFirstName": "TASHA",
"AuthorizedOfficialMiddleName": "R",
"AuthorizedOfficialTitle": "SOLE PROPRIETOR",
"AuthorizedOfficialNamePrefix": "MS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.S.CCC/SLP",
"AuthorizedOfficialTelephoneNumber": "816-373-4841",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "235Z00000X",
"TaxonomyName": "Speech-Language Pathologist",
"LicenseNumber": "116968",
"LicenseNumberStateCode": "MO",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}