{
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"FirstLineMailingAddress": "125 S JEFFERSON ST",
"SecondLineMailingAddress": "SUITE 306",
"MailingAddressCityName": "GREEN BAY",
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"MailingAddressCountryCode": "US",
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"MailingAddressFaxNumber": "920-437-5884",
"FirstLinePracticeLocationAddress": "125 S JEFFERSON ST",
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"PracticeLocationAddressFaxNumber": "920-437-5884",
"EnumerationDate": "09/20/2006",
"LastUpdateDate": "07/16/2008",
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"NPIReactivationDate": null,
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"AuthorizedOfficialLastName": "MERVILDE",
"AuthorizedOfficialFirstName": "KAREN",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Clinical Social Worker",
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"LicenseNumberStateCode": "WI",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}