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1821890872 NPI number — JESSICA ROSE SPOTTED BULL LAC

NPI Number: 1821890872
Health Care Provider/Practitioner: JESSICA ROSE SPOTTED BULL LAC

Information about “1821890872” NPI (JESSICA ROSE SPOTTED BULL LAC) exists in 1821890872 in HTML format HTML  |  1821890872 in plain Text format TXT  |  1821890872 in PDF (Portable Document Format) PDF  |  1821890872 in an XML format XML  formats.

NPI Number : 1821890872 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1821890872",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "SPOTTED BULL",
    "FirstName": "JESSICA",
    "MiddleName": "ROSE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LAC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 1098",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "POPLAR",
    "MailingAddressStateName": "MT",
    "MailingAddressPostalCode": "59255-1098",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "406-561-7872",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "417 EAST 13TH AVENUE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "POPLAR",
    "PracticeLocationAddressStateName": "MT",
    "PracticeLocationAddressPostalCode": "59255",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "406-768-3052",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/27/2025",
    "LastUpdateDate": "03/27/2025",
    "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": "BBH-LAC-LIC-78972",
        "LicenseNumberStateCode": "MT",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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