{
"Npi": {
"NPI": "1508638701",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "WALSH",
"FirstName": "JENNIFER",
"MiddleName": "PATRICIA",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "ED.D",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "TSURUTA",
"OtherFirstName": "JENNA",
"OtherMiddleName": "WALSH",
"OtherNamePrefix": "DR.",
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "2406 CLARK LN # B",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "REDONDO BEACH",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "90278-4424",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "310-977-4548",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2200 PACIFIC COAST HWY",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "HERMOSA BEACH",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "90254-2757",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "424-259-3450",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "10/23/2023",
"LastUpdateDate": "10/23/2023",
"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": "103TS0200X",
"TaxonomyName": "School Psychologist",
"LicenseNumber": "3325",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}