{
"Npi": {
"NPI": "1760991525",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "RIDDLE",
"FirstName": "JESSICA",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": "LLPC",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "VOUGHT",
"OtherFirstName": "JESSICA",
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "9249 W LAKE CITY RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "HOUGHTON LAKE",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "48629-9602",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "989-422-5122",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1840 W HOUGHTON LAKE DR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PRUDENVILLE",
"PracticeLocationAddressStateName": "MI",
"PracticeLocationAddressPostalCode": "48651-9672",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "989-390-9655",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/25/2017",
"LastUpdateDate": "08/20/2025",
"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": "101YP2500X",
"TaxonomyName": "Professional Counselor",
"LicenseNumber": "6451024510",
"LicenseNumberStateCode": "MI",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}