1689713174 NPI number — NANCY J UDOLPH LISW-S, PCC-S

NPI Number: 1689713174
Health Care Provider/Practitioner: NANCY J UDOLPH LISW-S, PCC-S

NPI Number : 1689713174 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1689713174",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "UDOLPH",
    "FirstName": "NANCY",
    "MiddleName": "J",
    "NamePrefix": "PROF.",
    "NameSuffix": null,
    "Credential": "LISW-S, PCC-S",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1227 EASTBROOK DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ASHLAND",
    "MailingAddressStateName": "OH",
    "MailingAddressPostalCode": "44805-3415",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "419-289-5372",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "19 W MAIN ST",
    "SecondLinePracticeLocationAddress": "SUITE 16",
    "PracticeLocationAddressCityName": "ASHLAND",
    "PracticeLocationAddressStateName": "OH",
    "PracticeLocationAddressPostalCode": "44805-2282",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "419-651-7669",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "02/05/2007",
    "LastUpdateDate": "12/16/2010",
    "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": "101YP2500X",
          "TaxonomyName": "Professional Counselor",
          "LicenseNumber": "E0000325",
          "LicenseNumberStateCode": "OH",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1041C0700X",
          "TaxonomyName": "Clinical Social Worker",
          "LicenseNumber": "I0002798",
          "LicenseNumberStateCode": "OH",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}