NPI Code Detail JSON Logo

1629755392 NPI number — ERINPATRICIA FLAHERTY BOMMERSBACH M.S., CCC-SLP

NPI Number: 1629755392
Health Care Provider/Practitioner: ERINPATRICIA FLAHERTY BOMMERSBACH M.S., CCC-SLP

Information about “1629755392” NPI (ERINPATRICIA FLAHERTY BOMMERSBACH M.S., CCC-SLP) exists in 1629755392 in HTML format HTML  |  1629755392 in plain Text format TXT  |  1629755392 in PDF (Portable Document Format) PDF  |  1629755392 in an XML format XML  formats.

NPI Number : 1629755392 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1629755392",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BOMMERSBACH",
    "FirstName": "ERINPATRICIA",
    "MiddleName": "FLAHERTY",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "M.S., CCC-SLP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "FLAHERTY",
    "OtherFirstName": "ERIN",
    "OtherMiddleName": "PATRICIA",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "M.S., CCC-SLP",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "2401 14TH AVE SW",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "DEVILS LAKE",
    "MailingAddressStateName": "ND",
    "MailingAddressPostalCode": "58301-8632",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "701-351-0988",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "213 5TH ST NE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "DEVILS LAKE",
    "PracticeLocationAddressStateName": "ND",
    "PracticeLocationAddressPostalCode": "58301-2425",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "701-662-2216",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/03/2023",
    "LastUpdateDate": "07/03/2023",
    "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": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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