{
"Npi": {
"NPI": "1902672074",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "BOWEN-GRAHAM",
"FirstName": "OLEN",
"MiddleName": "FOSS",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "CCC-SLP",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "PLATT",
"OtherFirstName": "ELLEN",
"OtherMiddleName": "GRAHAM",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "400 E EISENHOWER PKWY BLDG 2",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ANN ARBOR",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "48108-3302",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "734-232-3270",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "400 E EISENHOWER PKWY BLDG 2",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ANN ARBOR",
"PracticeLocationAddressStateName": "MI",
"PracticeLocationAddressPostalCode": "48108-3302",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "734-232-3270",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "11/30/2023",
"LastUpdateDate": "11/30/2023",
"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": "235Z00000X",
"TaxonomyName": "Speech-Language Pathologist",
"LicenseNumber": "7101008685",
"LicenseNumberStateCode": "MI",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}