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1477119576 NPI number — KRISTIN FASSHAUER QMHP

NPI Number: 1477119576
Health Care Provider/Practitioner: KRISTIN FASSHAUER QMHP

Information about “1477119576” NPI (KRISTIN FASSHAUER QMHP) exists in 1477119576 in HTML format HTML  |  1477119576 in plain Text format TXT  |  1477119576 in PDF (Portable Document Format) PDF  |  1477119576 in an XML format XML  formats.

NPI Number : 1477119576 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1477119576",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "FASSHAUER",
    "FirstName": "KRISTIN",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "QMHP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "10001 GRAND AVE STE 1",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "FRANKLIN PARK",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60131-2564",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "10001 GRAND AVE STE 1",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FRANKLIN PARK",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "60131-2564",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "847-451-8303",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "05/14/2019",
    "LastUpdateDate": "12/18/2025",
    "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": "101YM0800X",
          "TaxonomyName": "Mental Health Counselor",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YP2500X",
          "TaxonomyName": "Professional Counselor",
          "LicenseNumber": "180015344",
          "LicenseNumberStateCode": "IL",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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