{
"Npi": {
"NPI": "1790423200",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "WAGNER",
"FirstName": "LINDA",
"MiddleName": "KAY",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "LBSW",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "6638 PLEASANTVIEW ST NE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ROCKFORD",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "49341-8496",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "989-506-8237",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "376 E APPLE AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MUSKEGON",
"PracticeLocationAddressStateName": "MI",
"PracticeLocationAddressPostalCode": "49442-3466",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "231-724-1107",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "05/24/2022",
"LastUpdateDate": "05/24/2022",
"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": "104100000X",
"TaxonomyName": "Social Worker",
"LicenseNumber": "680263839",
"LicenseNumberStateCode": "MI",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}