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1609911882 NPI number — SHEILA A FUNK-JANSEN LISW, LCSW

NPI Number: 1609911882
Health Care Provider/Practitioner: SHEILA A FUNK-JANSEN LISW, LCSW

Information about “1609911882” NPI (SHEILA A FUNK-JANSEN LISW, LCSW) exists in 1609911882 in HTML format HTML  |  1609911882 in plain Text format TXT  |  1609911882 in PDF (Portable Document Format) PDF  |  1609911882 in an XML format XML  formats.

NPI Number : 1609911882 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1609911882",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "FUNK-JANSEN",
    "FirstName": "SHEILA",
    "MiddleName": "A",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LISW, LCSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "GARMON",
    "OtherFirstName": "SHEILA",
    "OtherMiddleName": "A",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "1536 W CENTRAL PARK AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "DAVENPORT",
    "MailingAddressStateName": "IA",
    "MailingAddressPostalCode": "52804-1741",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "660-216-1580",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2435 KIMBERLY RD STE 10N",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BETTENDORF",
    "PracticeLocationAddressStateName": "IA",
    "PracticeLocationAddressPostalCode": "52722-3572",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "660-216-1580",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "02/21/2007",
    "LastUpdateDate": "01/12/2024",
    "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": "149014820",
          "LicenseNumberStateCode": "IL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1041C0700X",
          "TaxonomyName": "Clinical Social Worker",
          "LicenseNumber": "2021025595",
          "LicenseNumberStateCode": "MO",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1041C0700X",
          "TaxonomyName": "Clinical Social Worker",
          "LicenseNumber": "007836",
          "LicenseNumberStateCode": "IA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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