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1801477377 NPI number — JENELL L HOLSTEAD PH.D., NCSP

NPI Number: 1801477377
Health Care Provider/Practitioner: JENELL L HOLSTEAD PH.D., NCSP

Information about “1801477377” NPI (JENELL L HOLSTEAD PH.D., NCSP) exists in 1801477377 in HTML format HTML  |  1801477377 in plain Text format TXT  |  1801477377 in PDF (Portable Document Format) PDF  |  1801477377 in an XML format XML  formats.

NPI Number : 1801477377 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1801477377",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "HOLSTEAD",
    "FirstName": "JENELL",
    "MiddleName": "L",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "PH.D., NCSP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1615 HIDDEN FALLS CT",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "DE PERE",
    "MailingAddressStateName": "WI",
    "MailingAddressPostalCode": "54115-3389",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "920-544-2780",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1050 CIRCLE DR STE B",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "GREEN BAY",
    "PracticeLocationAddressStateName": "WI",
    "PracticeLocationAddressPostalCode": "54304-5569",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "920-544-2780",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/16/2021",
    "LastUpdateDate": "04/16/2021",
    "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": "103TM1800X",
          "TaxonomyName": "Intellectual & Developmental Disabilities Psychologist",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "103TP0814X",
          "TaxonomyName": "Psychoanalysis Psychologist",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "103TP2701X",
          "TaxonomyName": "Group Psychotherapy Psychologist",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "103TS0200X",
          "TaxonomyName": "School Psychologist",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": [
        {
          "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."
        },
        {
          "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."
        }
      ]
    }
  }
}
                
            

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