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1801527221 NPI number — JESSICA MARILYN CAMPOLA CRM, CADC-R

NPI Number: 1801527221
Health Care Provider/Practitioner: JESSICA MARILYN CAMPOLA CRM, CADC-R

Information about “1801527221” NPI (JESSICA MARILYN CAMPOLA CRM, CADC-R) exists in 1801527221 in HTML format HTML  |  1801527221 in plain Text format TXT  |  1801527221 in PDF (Portable Document Format) PDF  |  1801527221 in an XML format XML  formats.

NPI Number : 1801527221 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1801527221",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "CAMPOLA",
    "FirstName": "JESSICA",
    "MiddleName": "MARILYN",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "CRM, CADC-R",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "335 SE LILLY AVE APT A",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CORVALLIS",
    "MailingAddressStateName": "OR",
    "MailingAddressPostalCode": "97333-1882",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "541-286-0147",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "426 NW 4TH ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CORVALLIS",
    "PracticeLocationAddressStateName": "OR",
    "PracticeLocationAddressPostalCode": "97330-6409",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "541-286-4439",
    "PracticeLocationAddressFaxNumber": "541-250-5178",
    "EnumerationDate": "06/17/2022",
    "LastUpdateDate": "06/17/2022",
    "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": "101YA0400X",
        "TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
        "LicenseNumber": "T-21-1323",
        "LicenseNumberStateCode": "OR",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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