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1588040273 NPI number — PATRICIA SUE COBURN

NPI Number: 1588040273
Health Care Provider/Practitioner: PATRICIA SUE COBURN

Information about “1588040273” NPI (PATRICIA SUE COBURN) exists in 1588040273 in HTML format HTML  |  1588040273 in plain Text format TXT  |  1588040273 in PDF (Portable Document Format) PDF  |  1588040273 in an XML format XML  formats.

NPI Number : 1588040273 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1588040273",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "COBURN",
    "FirstName": "PATRICIA",
    "MiddleName": "SUE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "BRODERICK",
    "OtherFirstName": "PATRICIA",
    "OtherMiddleName": "SUE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "LCSW",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "422 S MURDOCK DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PLEASANT GROVE",
    "MailingAddressStateName": "UT",
    "MailingAddressPostalCode": "84062-3278",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "801-319-6769",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "170 S INTERSTATE PLZ STE 100",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LEHI",
    "PracticeLocationAddressStateName": "UT",
    "PracticeLocationAddressPostalCode": "84043-8601",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "385-236-4500",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/04/2015",
    "LastUpdateDate": "09/30/2024",
    "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": "135358-3501",
        "LicenseNumberStateCode": "UT",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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