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1700021466 NPI number — JENNIFER SUSANNE KETCHUM LMT

NPI Number: 1700021466
Health Care Provider/Practitioner: JENNIFER SUSANNE KETCHUM LMT

Information about “1700021466” NPI (JENNIFER SUSANNE KETCHUM LMT) exists in 1700021466 in HTML format HTML  |  1700021466 in plain Text format TXT  |  1700021466 in PDF (Portable Document Format) PDF  |  1700021466 in an XML format XML  formats.

NPI Number : 1700021466 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1700021466",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "KETCHUM",
    "FirstName": "JENNIFER",
    "MiddleName": "SUSANNE",
    "NamePrefix": "MS.",
    "NameSuffix": null,
    "Credential": "LMT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "BROWN",
    "OtherFirstName": "JENNIFER",
    "OtherMiddleName": "SUSANNE",
    "OtherNamePrefix": "MRS.",
    "OtherNameSuffix": null,
    "OtherCredential": "CMT",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "2600 EATON RAPIDS RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LANSING",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "48911",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "517-887-7599",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2600 EATON RAPIDS RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LANSING",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "48911",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "517-887-7599",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "12/10/2008",
    "LastUpdateDate": "03/26/2020",
    "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": "225700000X",
          "TaxonomyName": "Massage Therapist",
          "LicenseNumber": null,
          "LicenseNumberStateCode": "MI",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "225700000X",
          "TaxonomyName": "Massage Therapist",
          "LicenseNumber": "7501004034",
          "LicenseNumberStateCode": "MI",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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