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1811686496 NPI number — HANNAH VICTORIA CRAUDELL SUDPT

NPI Number: 1811686496
Health Care Provider/Practitioner: HANNAH VICTORIA CRAUDELL SUDPT

Information about “1811686496” NPI (HANNAH VICTORIA CRAUDELL SUDPT) exists in 1811686496 in HTML format HTML  |  1811686496 in plain Text format TXT  |  1811686496 in PDF (Portable Document Format) PDF  |  1811686496 in an XML format XML  formats.

NPI Number : 1811686496 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1811686496",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "CRAUDELL",
    "FirstName": "HANNAH",
    "MiddleName": "VICTORIA",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "SUDPT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "ALLEN",
    "OtherFirstName": "HANNAH",
    "OtherMiddleName": "VICTORIA",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "6005 TYEE DR SW",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "TUMWATER",
    "MailingAddressStateName": "WA",
    "MailingAddressPostalCode": "98512-7356",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "360-464-6700",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "807 W PINE ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SHELTON",
    "PracticeLocationAddressStateName": "WA",
    "PracticeLocationAddressPostalCode": "98584-2562",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "360-426-7664",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "05/01/2023",
    "LastUpdateDate": "09/23/2024",
    "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": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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