NPI Code Detail JSON Logo

1760974091 NPI number — ANNA MARIE KOELZER MA, CCC-SLP

NPI Number: 1760974091
Health Care Provider/Practitioner: ANNA MARIE KOELZER MA, CCC-SLP

Information about “1760974091” NPI (ANNA MARIE KOELZER MA, CCC-SLP) exists in 1760974091 in HTML format HTML  |  1760974091 in plain Text format TXT  |  1760974091 in PDF (Portable Document Format) PDF  |  1760974091 in an XML format XML  formats.

NPI Number : 1760974091 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1760974091",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "KOELZER",
    "FirstName": "ANNA MARIE",
    "MiddleName": null,
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "MA, CCC-SLP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "SANDERFORD",
    "OtherFirstName": "ANNA MARIE",
    "OtherMiddleName": null,
    "OtherNamePrefix": "MS.",
    "OtherNameSuffix": null,
    "OtherCredential": "MA, CCC-SLP",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "108 1ST AVE SE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MINOT",
    "MailingAddressStateName": "ND",
    "MailingAddressPostalCode": "58701-3926",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "832-930-3105",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "180 MONTGOMERY ST STE 1850",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SAN FRANCISCO",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "94104-4278",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "832-930-3105",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "06/01/2018",
    "LastUpdateDate": "08/29/2022",
    "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": "31960",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "235Z00000X",
          "TaxonomyName": "Speech-Language Pathologist",
          "LicenseNumber": "1809",
          "LicenseNumberStateCode": "ND",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "235Z00000X",
          "TaxonomyName": "Speech-Language Pathologist",
          "LicenseNumber": "113421",
          "LicenseNumberStateCode": "TX",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "235Z00000X",
          "TaxonomyName": "Speech-Language Pathologist",
          "LicenseNumber": "14297933",
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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