{
"Npi": {
"NPI": "1497999361",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "AMY MICKLICH SPEECH LANGUAGE PATHOLOGY SERVICES",
"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": "293 SPRING ST.",
"SecondLineMailingAddress": "P.O. BOX 69",
"MailingAddressCityName": "ROCKVILLE",
"MailingAddressStateName": "RI",
"MailingAddressPostalCode": "02873-0069",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "401-578-8348",
"MailingAddressFaxNumber": "401-539-2319",
"FirstLinePracticeLocationAddress": "293 SPRING ST.",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ROCKVILLE",
"PracticeLocationAddressStateName": "RI",
"PracticeLocationAddressPostalCode": "02873-0069",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "401-578-8348",
"PracticeLocationAddressFaxNumber": "401-539-2319",
"EnumerationDate": "04/23/2009",
"LastUpdateDate": "04/23/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MICKLICH",
"AuthorizedOfficialFirstName": "AMY",
"AuthorizedOfficialMiddleName": "L.",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "MS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "401-578-8348",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "235Z00000X",
"TaxonomyName": "Speech-Language Pathologist",
"LicenseNumber": "SP00578",
"LicenseNumberStateCode": "RI",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}