{
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"FirstLineMailingAddress": "1036 N HAMLIN AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CHICAGO",
"MailingAddressStateName": "IL",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "773-853-9832",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1036 N. HAMLIN AVE",
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"PracticeLocationAddressCityName": "CHICAGO",
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"EnumerationDate": "01/23/2012",
"LastUpdateDate": "01/23/2012",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MITCHEM",
"AuthorizedOfficialFirstName": "DONNA",
"AuthorizedOfficialMiddleName": "MARIE",
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"AuthorizedOfficialTelephoneNumber": "773-853-9832",
"Taxonomies": {
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"TaxonomyName": "Early Intervention Provider Agency",
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}