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1710331921 NPI number — TIFFANY TRASK

NPI Number: 1710331921
Health Care Provider/Practitioner: TIFFANY TRASK

Information about “1710331921” NPI (TIFFANY TRASK) exists in 1710331921 in HTML format HTML  |  1710331921 in plain Text format TXT  |  1710331921 in PDF (Portable Document Format) PDF  |  1710331921 in an XML format XML  formats.

NPI Number : 1710331921 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1710331921",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "TRASK",
    "FirstName": "TIFFANY",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "13455 ROCKWOOD RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "RAPID CITY",
    "MailingAddressStateName": "SD",
    "MailingAddressPostalCode": "57702-6502",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "605-209-8792",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "4447 S CANYON RD STE 6",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "RAPID CITY",
    "PracticeLocationAddressStateName": "SD",
    "PracticeLocationAddressPostalCode": "57702-1889",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "605-443-6164",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/14/2016",
    "LastUpdateDate": "07/11/2022",
    "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": "235Z00000X",
          "TaxonomyName": "Speech-Language Pathologist",
          "LicenseNumber": "14037899",
          "LicenseNumberStateCode": "SD",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "235Z00000X",
          "TaxonomyName": "Speech-Language Pathologist",
          "LicenseNumber": "429-SLP",
          "LicenseNumberStateCode": "SD",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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