{
"Npi": {
"NPI": "1942067343",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "PAUCHFENTON",
"FirstName": "JACQUELINE",
"MiddleName": "LOUISE",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "M.ED.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "PAUCH-FENTON",
"OtherFirstName": "JACQUELINE",
"OtherMiddleName": "LOUISE",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "M.ED.",
"OtherLastNameTypeCode": "5",
"FirstLineMailingAddress": "172 N SUMMIT RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GREENVILLE",
"MailingAddressStateName": "PA",
"MailingAddressPostalCode": "16125-9227",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "724-977-7513",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "172 N SUMMIT RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "GREENVILLE",
"PracticeLocationAddressStateName": "PA",
"PracticeLocationAddressPostalCode": "16125-9227",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "724-977-7513",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/01/2024",
"LastUpdateDate": "03/01/2024",
"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": "103K00000X",
"TaxonomyName": "Behavior Analyst",
"LicenseNumber": "BH002581",
"LicenseNumberStateCode": "PA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}