NPI Code Detail JSON Logo

1437452018 NPI number — JORDAN MICHELLE HENDRICKSON PSYD

NPI Number: 1437452018
Health Care Provider/Practitioner: JORDAN MICHELLE HENDRICKSON PSYD

Information about “1437452018” NPI (JORDAN MICHELLE HENDRICKSON PSYD) exists in 1437452018 in HTML format HTML  |  1437452018 in plain Text format TXT  |  1437452018 in PDF (Portable Document Format) PDF  |  1437452018 in an XML format XML  formats.

NPI Number : 1437452018 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1437452018",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "HENDRICKSON",
    "FirstName": "JORDAN",
    "MiddleName": "MICHELLE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PSYD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "LUTEY",
    "OtherFirstName": "JORDAN",
    "OtherMiddleName": "MICHELLE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "4400 NE 77TH AVE STE 275",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "VANCOUVER",
    "MailingAddressStateName": "WA",
    "MailingAddressPostalCode": "98662-6857",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "503-709-3295",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "4400 NE 77TH AVE STE 275",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "VANCOUVER",
    "PracticeLocationAddressStateName": "WA",
    "PracticeLocationAddressPostalCode": "98662-6857",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "503-709-3295",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "12/21/2010",
    "LastUpdateDate": "09/28/2021",
    "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": "103TC0700X",
          "TaxonomyName": "Clinical Psychologist",
          "LicenseNumber": "PY60949986",
          "LicenseNumberStateCode": "WA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "103TC0700X",
          "TaxonomyName": "Clinical Psychologist",
          "LicenseNumber": "PSYPSYLIC3612",
          "LicenseNumberStateCode": "MT",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "103TC0700X",
          "TaxonomyName": "Clinical Psychologist",
          "LicenseNumber": "2608",
          "LicenseNumberStateCode": "OR",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

Copyright © 2007-2026 Data Labs Health. All rights reserved.