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1447574702 NPI number — THERESA A ELLISON CSAC

NPI Number: 1447574702
Health Care Provider/Practitioner: THERESA A ELLISON CSAC

Information about “1447574702” NPI (THERESA A ELLISON CSAC) exists in 1447574702 in HTML format HTML  |  1447574702 in plain Text format TXT  |  1447574702 in PDF (Portable Document Format) PDF  |  1447574702 in an XML format XML  formats.

NPI Number : 1447574702 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1447574702",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "ELLISON",
    "FirstName": "THERESA",
    "MiddleName": "A",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "CSAC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "CONSTANCE",
    "OtherFirstName": "THERESA",
    "OtherMiddleName": "A.",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "CSAC",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "17230 95TH AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CHIPPEWA FALLS",
    "MailingAddressStateName": "WI",
    "MailingAddressPostalCode": "54729-5189",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "715-896-3555",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "13 BAY ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CHIPPEWA FALLS",
    "PracticeLocationAddressStateName": "WI",
    "PracticeLocationAddressPostalCode": "54729-2437",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "715-726-9023",
    "PracticeLocationAddressFaxNumber": "715-726-9055",
    "EnumerationDate": "03/16/2010",
    "LastUpdateDate": "03/16/2010",
    "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": "101YA0400X",
        "TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
        "LicenseNumber": "13165",
        "LicenseNumberStateCode": "WI",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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