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1477721637 NPI number — WILLIAM F JENSEN MBA, ICADC

NPI Number: 1477721637
Health Care Provider/Practitioner: WILLIAM F JENSEN MBA, ICADC

Information about “1477721637” NPI (WILLIAM F JENSEN MBA, ICADC) exists in 1477721637 in HTML format HTML  |  1477721637 in plain Text format TXT  |  1477721637 in PDF (Portable Document Format) PDF  |  1477721637 in an XML format XML  formats.

NPI Number : 1477721637 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1477721637",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "JENSEN",
    "FirstName": "WILLIAM",
    "MiddleName": "F",
    "NamePrefix": "MR.",
    "NameSuffix": null,
    "Credential": "MBA, ICADC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "JENSEN",
    "OtherFirstName": "BILL",
    "OtherMiddleName": "F",
    "OtherNamePrefix": "MR.",
    "OtherNameSuffix": null,
    "OtherCredential": "MBA, ICADC",
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "2975 OVERLAND AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BURLEY",
    "MailingAddressStateName": "ID",
    "MailingAddressPostalCode": "83318-3231",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "208-878-2600",
    "MailingAddressFaxNumber": "208-878-1336",
    "FirstLinePracticeLocationAddress": "2975 OVERLAND AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BURLEY",
    "PracticeLocationAddressStateName": "ID",
    "PracticeLocationAddressPostalCode": "83318-3231",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "208-878-2600",
    "PracticeLocationAddressFaxNumber": "208-878-1336",
    "EnumerationDate": "02/11/2008",
    "LastUpdateDate": "02/11/2008",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "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": "1006393",
        "LicenseNumberStateCode": "ID",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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