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1528007333 NPI number — MERLE FOSSUM MSW

NPI Number: 1528007333
Health Care Provider/Practitioner: MERLE FOSSUM MSW

Information about “1528007333” NPI (MERLE FOSSUM MSW) exists in 1528007333 in HTML format HTML  |  1528007333 in plain Text format TXT  |  1528007333 in PDF (Portable Document Format) PDF  |  1528007333 in an XML format XML  formats.

NPI Number : 1528007333 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1528007333",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "X",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "FOSSUM",
    "FirstName": "MERLE",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "7701 NORMANDALE RD",
    "SecondLineMailingAddress": "SUITE #100",
    "MailingAddressCityName": "EDINA",
    "MailingAddressStateName": "MN",
    "MailingAddressPostalCode": "55435-5310",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "651-225-4675",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "7701 NORMANDALE RD",
    "SecondLinePracticeLocationAddress": "SUITE #100",
    "PracticeLocationAddressCityName": "EDINA",
    "PracticeLocationAddressStateName": "MN",
    "PracticeLocationAddressPostalCode": "55435-5310",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "651-225-4675",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "06/06/2006",
    "LastUpdateDate": "09/11/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "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": "5417",
          "LicenseNumberStateCode": "MN",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "106H00000X",
          "TaxonomyName": "Marriage & Family Therapist",
          "LicenseNumber": "99",
          "LicenseNumberStateCode": "MN",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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