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1518241355 NPI number — KATRINA MARIE LISIK LBSW

NPI Number: 1518241355
Health Care Provider/Practitioner: KATRINA MARIE LISIK LBSW

Information about “1518241355” NPI (KATRINA MARIE LISIK LBSW) exists in 1518241355 in HTML format HTML  |  1518241355 in plain Text format TXT  |  1518241355 in PDF (Portable Document Format) PDF  |  1518241355 in an XML format XML  formats.

NPI Number : 1518241355 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1518241355",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "LISIK",
    "FirstName": "KATRINA",
    "MiddleName": "MARIE",
    "NamePrefix": "MS.",
    "NameSuffix": null,
    "Credential": "LBSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "TARALA",
    "OtherFirstName": "KATRINIA",
    "OtherMiddleName": "MARIE",
    "OtherNamePrefix": "MS.",
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "70 LAFAYETTE ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PONTIAC",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "48342-2033",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "248-338-7458",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "3353 HOSPITAL RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SAGINAW",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "48603-9622",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "989-746-9633",
    "PracticeLocationAddressFaxNumber": "989-790-1488",
    "EnumerationDate": "09/28/2011",
    "LastUpdateDate": "09/28/2011",
    "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": "104100000X",
        "TaxonomyName": "Social Worker",
        "LicenseNumber": "6802086512",
        "LicenseNumberStateCode": "MI",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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