{
"Npi": {
"NPI": "1477992188",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "JACKSON",
"FirstName": "LATOSHA",
"MiddleName": "M",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "LICSW",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "DUESTER",
"OtherFirstName": "LATOSHA",
"OtherMiddleName": "M",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "MSW",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "1 HARDY RD # 128",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BEDFORD",
"MailingAddressStateName": "NH",
"MailingAddressPostalCode": "03110-4915",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "402-469-6899",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "6 CHENELL DR STE 100",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CONCORD",
"PracticeLocationAddressStateName": "NH",
"PracticeLocationAddressPostalCode": "03301-8514",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "402-469-6899",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "06/17/2013",
"LastUpdateDate": "12/23/2021",
"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": "2108",
"LicenseNumberStateCode": "NE",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "1041C0700X",
"TaxonomyName": "Clinical Social Worker",
"LicenseNumber": "1822",
"LicenseNumberStateCode": "NE",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "1041C0700X",
"TaxonomyName": "Clinical Social Worker",
"LicenseNumber": "2138",
"LicenseNumberStateCode": "NH",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}