{
"Npi": {
"NPI": "1962025833",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "EVERGREEN",
"FirstName": "SARAH",
"MiddleName": "JANE",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "LCSW",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "BENKENDORF",
"OtherFirstName": "SARAH",
"OtherMiddleName": "JANE",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "LMSW",
"OtherLastNameTypeCode": "5",
"FirstLineMailingAddress": "5101 COLOGNE AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SAINT LOUIS",
"MailingAddressStateName": "MO",
"MailingAddressPostalCode": "63116-1316",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "314-437-3402",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1295 BANDANA BLVD N STE 210",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SAINT PAUL",
"PracticeLocationAddressStateName": "MN",
"PracticeLocationAddressPostalCode": "55108-5115",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "888-272-0784",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "05/26/2020",
"LastUpdateDate": "10/18/2024",
"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": "104100000X",
"TaxonomyName": "Social Worker",
"LicenseNumber": "2019020234",
"LicenseNumberStateCode": "MO",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}