{
"Npi": {
"NPI": "1598036030",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SPEECH WORKS, LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "5 COUNTY ROAD 7290",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WYNNE",
"MailingAddressStateName": "AR",
"MailingAddressPostalCode": "72396-8121",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "870-270-7963",
"MailingAddressFaxNumber": "870-374-6061",
"FirstLinePracticeLocationAddress": "111 MERRIMAN AVE E",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WYNNE",
"PracticeLocationAddressStateName": "AR",
"PracticeLocationAddressPostalCode": "72396-2941",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "870-270-7963",
"PracticeLocationAddressFaxNumber": "870-697-2296",
"EnumerationDate": "01/13/2012",
"LastUpdateDate": "12/05/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "FREDERICK",
"AuthorizedOfficialFirstName": "JAMIE",
"AuthorizedOfficialMiddleName": "L",
"AuthorizedOfficialTitle": "SLP",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "870-270-7963",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "235Z00000X",
"TaxonomyName": "Speech-Language Pathologist",
"LicenseNumber": "SP#3079",
"LicenseNumberStateCode": "AR",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}