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1679959654 NPI number — JUSTINA KIMMEL MSW, LCSW

NPI Number: 1679959654
Health Care Provider/Practitioner: JUSTINA KIMMEL MSW, LCSW

Information about “1679959654” NPI (JUSTINA KIMMEL MSW, LCSW) exists in 1679959654 in HTML format HTML  |  1679959654 in plain Text format TXT  |  1679959654 in PDF (Portable Document Format) PDF  |  1679959654 in an XML format XML  formats.

NPI Number : 1679959654 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1679959654",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "KIMMEL",
    "FirstName": "JUSTINA",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MSW, LCSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "OLRICK",
    "OtherFirstName": "JUSTINA",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "717 SOUTH BLVD STE 9",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BARABOO",
    "MailingAddressStateName": "WI",
    "MailingAddressPostalCode": "53913-3139",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "608-630-1519",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "717 SOUTH BLVD STE 9",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BARABOO",
    "PracticeLocationAddressStateName": "WI",
    "PracticeLocationAddressPostalCode": "53913-3139",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "608-630-1519",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/03/2015",
    "LastUpdateDate": "05/27/2021",
    "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": "104100000X",
          "TaxonomyName": "Social Worker",
          "LicenseNumber": "129537-121",
          "LicenseNumberStateCode": "WI",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1041C0700X",
          "TaxonomyName": "Clinical Social Worker",
          "LicenseNumber": "8801",
          "LicenseNumberStateCode": "WI",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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