{
"Npi": {
"NPI": "1558578872",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "GRAY",
"FirstName": "LISA",
"MiddleName": "MARIE",
"NamePrefix": "MISS",
"NameSuffix": null,
"Credential": "M.S. CCC-SLP",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "MCNAMARA",
"OtherFirstName": "LISA",
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "M.S. CCC-SLP",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "2 LATTICELEAF PL",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "THE WOODLANDS",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "77382-5311",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "314-709-0737",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "11660 CRANEBROOK DR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "THE WOODLANDS",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "77382-5807",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "832-465-5913",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "05/17/2007",
"LastUpdateDate": "09/23/2022",
"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": "2007012831",
"LicenseNumberStateCode": "MO",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "235Z00000X",
"TaxonomyName": "Speech-Language Pathologist",
"LicenseNumber": "SLP5639",
"LicenseNumberStateCode": "AZ",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}