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1558953398 NPI number — LINDSEY NICHOLE PETRICK LCSW

NPI Number: 1558953398
Health Care Provider/Practitioner: LINDSEY NICHOLE PETRICK LCSW

Information about “1558953398” NPI (LINDSEY NICHOLE PETRICK LCSW) exists in 1558953398 in HTML format HTML  |  1558953398 in plain Text format TXT  |  1558953398 in PDF (Portable Document Format) PDF  |  1558953398 in an XML format XML  formats.

NPI Number : 1558953398 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1558953398",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "PETRICK",
    "FirstName": "LINDSEY",
    "MiddleName": "NICHOLE",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "LCSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "4926 N ORCHID LN",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "COEUR D ALENE",
    "MailingAddressStateName": "ID",
    "MailingAddressPostalCode": "83815-8748",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "208-755-1641",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "13403 N GOVERNMENT WAY STE 319",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "HAYDEN",
    "PracticeLocationAddressStateName": "ID",
    "PracticeLocationAddressPostalCode": "83835-8905",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "208-755-1641",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "02/03/2021",
    "LastUpdateDate": "12/20/2022",
    "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": "1041C0700X",
          "TaxonomyName": "Clinical Social Worker",
          "LicenseNumber": "41681",
          "LicenseNumberStateCode": "ID",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "104100000X",
          "TaxonomyName": "Social Worker",
          "LicenseNumber": "37776",
          "LicenseNumberStateCode": "ID",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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