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1740540848 NPI number — EMILY R GOMEZTAGLE MS-SLP-CCC

NPI Number: 1740540848
Health Care Provider/Practitioner: EMILY R GOMEZTAGLE MS-SLP-CCC

Information about “1740540848” NPI (EMILY R GOMEZTAGLE MS-SLP-CCC) exists in 1740540848 in HTML format HTML  |  1740540848 in plain Text format TXT  |  1740540848 in PDF (Portable Document Format) PDF  |  1740540848 in an XML format XML  formats.

NPI Number : 1740540848 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1740540848",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GOMEZTAGLE",
    "FirstName": "EMILY",
    "MiddleName": "R",
    "NamePrefix": "MISS",
    "NameSuffix": null,
    "Credential": "MS-SLP-CCC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2348 N LISTER AVE",
    "SecondLineMailingAddress": "207",
    "MailingAddressCityName": "CHICAGO",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60614-2994",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "219-308-9477",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "5130 W JACKSON BLVD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CHICAGO",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "60644-4332",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "219-308-9477",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "05/22/2012",
    "LastUpdateDate": "03/07/2014",
    "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": "390200000X",
          "TaxonomyName": "Student in an Organized Health Care Education/Training Program",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "235Z00000X",
          "TaxonomyName": "Speech-Language Pathologist",
          "LicenseNumber": "146011739",
          "LicenseNumberStateCode": "IL",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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