{
"Npi": {
"NPI": "1447617063",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "WILLIAMS",
"FirstName": "WYNNE",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": "M.A.,C.C.C-SLP",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "252 KENWOOD CT",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GROSSE POINTE FARMS",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "48236-3451",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "313-330-8199",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "131 KERCHEVAL AVE",
"SecondLinePracticeLocationAddress": "SUITE 75",
"PracticeLocationAddressCityName": "GROSSE POINTE FARMS",
"PracticeLocationAddressStateName": "MI",
"PracticeLocationAddressPostalCode": "48236-3629",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "313-330-8199",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "01/27/2016",
"LastUpdateDate": "01/27/2016",
"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": "235Z00000X",
"TaxonomyName": "Speech-Language Pathologist",
"LicenseNumber": "7101003405",
"LicenseNumberStateCode": "MI",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}