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1497016752 NPI number — ANDREA LINETTE GROSSKURTH LICSW

NPI Number: 1497016752
Health Care Provider/Practitioner: ANDREA LINETTE GROSSKURTH LICSW

Information about “1497016752” NPI (ANDREA LINETTE GROSSKURTH LICSW) exists in 1497016752 in HTML format HTML  |  1497016752 in plain Text format TXT  |  1497016752 in PDF (Portable Document Format) PDF  |  1497016752 in an XML format XML  formats.

NPI Number : 1497016752 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1497016752",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GROSSKURTH",
    "FirstName": "ANDREA",
    "MiddleName": "LINETTE",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "LICSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "JOHNSON",
    "OtherFirstName": "ANDREA",
    "OtherMiddleName": "LINETTE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "6809 122ND AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "KENOSHA",
    "MailingAddressStateName": "WI",
    "MailingAddressPostalCode": "53142-7335",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "262-652-5522",
    "MailingAddressFaxNumber": "262-652-7228",
    "FirstLinePracticeLocationAddress": "6809 122ND AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "KENOSHA",
    "PracticeLocationAddressStateName": "WI",
    "PracticeLocationAddressPostalCode": "53142-7335",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "262-652-5522",
    "PracticeLocationAddressFaxNumber": "262-652-7228",
    "EnumerationDate": "06/04/2012",
    "LastUpdateDate": "11/23/2020",
    "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": "1041C0700X",
        "TaxonomyName": "Clinical Social Worker",
        "LicenseNumber": "8609",
        "LicenseNumberStateCode": "WI",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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