{
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"IsOrgSubpart": "N",
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"OrgName": "KIMBERLY D NIELSEN, PLLC",
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"FirstLineMailingAddress": "15396 N 83RD AVE STE F101",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PEORIA",
"MailingAddressStateName": "AZ",
"MailingAddressPostalCode": "85381-5629",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "623-640-7940",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "15396 N 83RD AVE STE F101",
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"PracticeLocationAddressCityName": "PEORIA",
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"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "01/12/2012",
"LastUpdateDate": "01/12/2012",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "NIELSEN",
"AuthorizedOfficialFirstName": "KIMBERLY",
"AuthorizedOfficialMiddleName": "DAWN",
"AuthorizedOfficialTitle": "CHILD AND FAMILY THERAPIST",
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"AuthorizedOfficialCredential": "LCSW",
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1041C0700X",
"TaxonomyName": "Clinical Social Worker",
"LicenseNumber": "LCSW1099",
"LicenseNumberStateCode": "AZ",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}