NPI Code Detail JSON Logo

1457159386 NPI number — THE BLACK SHEEP SANCTUARY PLLC

NPI Number: 1457159386
Health Care Provider/Practitioner: THE BLACK SHEEP SANCTUARY PLLC

Information about “1457159386” NPI (THE BLACK SHEEP SANCTUARY PLLC) exists in 1457159386 in HTML format HTML  |  1457159386 in plain Text format TXT  |  1457159386 in PDF (Portable Document Format) PDF  |  1457159386 in an XML format XML  formats.

NPI Number : 1457159386 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1457159386",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "THE BLACK SHEEP SANCTUARY PLLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "136 TERRACE DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "DEKALB",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60115-1936",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "630-709-1471",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "3080 OGDEN AVE STE 104",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LISLE",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "60532-1693",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "630-423-6244",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/06/2025",
    "LastUpdateDate": "04/02/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "VANDERPLOW",
    "AuthorizedOfficialFirstName": "SAMANTHA",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "MANAGER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "LCSW",
    "AuthorizedOfficialTelephoneNumber": "630-709-1471",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "1041C0700X",
        "TaxonomyName": "Clinical Social Worker",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
      }
    }
  }
}
                
            

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