{
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"FirstLineMailingAddress": "600 N DEARBORN ST",
"SecondLineMailingAddress": "#1308",
"MailingAddressCityName": "CHICAGO",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60654-6284",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "312-751-9677",
"MailingAddressFaxNumber": "312-751-9677",
"FirstLinePracticeLocationAddress": "1034 WARREN AVE",
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"PracticeLocationAddressCityName": "DOWNERS GROVE",
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"PracticeLocationAddressFaxNumber": "312-751-9677",
"EnumerationDate": "01/28/2009",
"LastUpdateDate": "02/03/2012",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LAROSE",
"AuthorizedOfficialFirstName": "ROGER",
"AuthorizedOfficialMiddleName": "WALTER",
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"AuthorizedOfficialTelephoneNumber": "312-730-7339",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Audiologist",
"LicenseNumber": "147.000224",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}