{
"Npi": {
"NPI": "1548068232",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "CAMACHO",
"FirstName": "CARRIE",
"MiddleName": null,
"NamePrefix": "MRS.",
"NameSuffix": null,
"Credential": "MS, CF-SLP",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "DECKER",
"OtherFirstName": "CARRIE",
"OtherMiddleName": "LYNN",
"OtherNamePrefix": "MS.",
"OtherNameSuffix": null,
"OtherCredential": "N/A",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "1941 BOULTON WAY",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MARYSVILLE",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "95901-3813",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "510-213-4487",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1625 STOCKTON BLVD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SACRAMENTO",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "95816-7097",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "510-213-4487",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/06/2025",
"LastUpdateDate": "03/06/2025",
"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": "235Z00000X",
"TaxonomyName": "Speech-Language Pathologist",
"LicenseNumber": "20284",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}