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1720809817 NPI number — CIERA ELIZABETH TRAYLOR LSW

NPI Number: 1720809817
Health Care Provider/Practitioner: CIERA ELIZABETH TRAYLOR LSW

Information about “1720809817” NPI (CIERA ELIZABETH TRAYLOR LSW) exists in 1720809817 in HTML format HTML  |  1720809817 in plain Text format TXT  |  1720809817 in PDF (Portable Document Format) PDF  |  1720809817 in an XML format XML  formats.

NPI Number : 1720809817 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1720809817",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "TRAYLOR",
    "FirstName": "CIERA",
    "MiddleName": "ELIZABETH",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "TRAYLOR",
    "OtherFirstName": "CIERA",
    "OtherMiddleName": "ELIZABETH",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "LSW",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "3903 INDIANAPOLIS BLVD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "EAST CHICAGO",
    "MailingAddressStateName": "IN",
    "MailingAddressPostalCode": "46312-2555",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "219-769-4005",
    "MailingAddressFaxNumber": "219-392-6998",
    "FirstLinePracticeLocationAddress": "3903 INDIANAPOLIS BLVD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "EAST CHICAGO",
    "PracticeLocationAddressStateName": "IN",
    "PracticeLocationAddressPostalCode": "46312-2555",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "219-392-6029",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "10/21/2024",
    "LastUpdateDate": "10/21/2024",
    "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": "104100000X",
          "TaxonomyName": "Social Worker",
          "LicenseNumber": "33012373A",
          "LicenseNumberStateCode": "IN",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "104100000X",
          "TaxonomyName": "Social Worker",
          "LicenseNumber": "150113546",
          "LicenseNumberStateCode": "IL",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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