{
"Npi": {
"NPI": "1659251494",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "WANDERSEE",
"FirstName": "JUSTYCE",
"MiddleName": "ALEXANDRIA",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "APSW",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "623 ARLINGTON WAY",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WATERTOWN",
"MailingAddressStateName": "WI",
"MailingAddressPostalCode": "53094-5917",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "414-363-0905",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "115 N CENTER ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BEAVER DAM",
"PracticeLocationAddressStateName": "WI",
"PracticeLocationAddressPostalCode": "53916-2119",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "920-877-1766",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/03/2025",
"LastUpdateDate": "09/03/2025",
"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": "135761121",
"LicenseNumberStateCode": "WI",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}