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1689715906 NPI number — ROBERTA (BOBBIE) JEANNE WENDEROTH MA, LCPC

NPI Number: 1689715906
Health Care Provider/Practitioner: ROBERTA (BOBBIE) JEANNE WENDEROTH MA, LCPC

Information about “1689715906” NPI (ROBERTA (BOBBIE) JEANNE WENDEROTH MA, LCPC) exists in 1689715906 in HTML format HTML  |  1689715906 in plain Text format TXT  |  1689715906 in PDF (Portable Document Format) PDF  |  1689715906 in an XML format XML  formats.

NPI Number : 1689715906 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1689715906",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WENDEROTH",
    "FirstName": "ROBERTA (BOBBIE)",
    "MiddleName": "JEANNE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MA, LCPC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "3624 SOUTH AVE W",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MISSOULA",
    "MailingAddressStateName": "MT",
    "MailingAddressPostalCode": "59804-6310",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "406-207-3342",
    "MailingAddressFaxNumber": "406-721-3394",
    "FirstLinePracticeLocationAddress": "1048 BURLINGTON AVE",
    "SecondLinePracticeLocationAddress": "SUITE 100",
    "PracticeLocationAddressCityName": "MISSOULA",
    "PracticeLocationAddressStateName": "MT",
    "PracticeLocationAddressPostalCode": "59801-5683",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "406-207-3342",
    "PracticeLocationAddressFaxNumber": "406-721-3394",
    "EnumerationDate": "02/09/2007",
    "LastUpdateDate": "07/09/2007",
    "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": "1276-LCPC",
        "LicenseNumberStateCode": "MT",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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