{
"Npi": {
"NPI": "1811055700",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "SIMON",
"FirstName": "ANJULI",
"MiddleName": "IVETTE",
"NamePrefix": "MISS",
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "WAGERS",
"OtherFirstName": "ANJULI",
"OtherMiddleName": "IVETTE",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "LPC, CSAC, ICS",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "1613 11 1/2 ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BARRON",
"MailingAddressStateName": "WI",
"MailingAddressPostalCode": "54812-9022",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "715-553-0328",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "335 E MONROE AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BARRON",
"PracticeLocationAddressStateName": "WI",
"PracticeLocationAddressPostalCode": "54812-1479",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "715-537-6174",
"PracticeLocationAddressFaxNumber": "715-537-6848",
"EnumerationDate": "12/05/2006",
"LastUpdateDate": "02/27/2020",
"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": "15442-132",
"LicenseNumberStateCode": "WI",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "101Y00000X",
"TaxonomyName": "Counselor",
"LicenseNumber": "3692125",
"LicenseNumberStateCode": "WI",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}