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1639464100 NPI number — ANGELA NICOLE FRAGEMAN SLP

NPI Number: 1639464100
Health Care Provider/Practitioner: ANGELA NICOLE FRAGEMAN SLP

Information about “1639464100” NPI (ANGELA NICOLE FRAGEMAN SLP) exists in 1639464100 in HTML format HTML  |  1639464100 in plain Text format TXT  |  1639464100 in PDF (Portable Document Format) PDF  |  1639464100 in an XML format XML  formats.

NPI Number : 1639464100 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1639464100",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "FRAGEMAN",
    "FirstName": "ANGELA",
    "MiddleName": "NICOLE",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "SLP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "MCGINNIS",
    "OtherFirstName": "ANGELA",
    "OtherMiddleName": "N.",
    "OtherNamePrefix": "MISS",
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "3224 ACADIA WAY",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "QUINCY",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "62301-7401",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "217-440-5600",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1025 MAINE ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "QUINCY",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "62301-4038",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "217-222-6550",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "06/13/2011",
    "LastUpdateDate": "06/06/2013",
    "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": "242.001609",
        "LicenseNumberStateCode": "IL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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