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1962762534 NPI number — LORI JO POOLE LCSW

NPI Number: 1962762534
Health Care Provider/Practitioner: LORI JO POOLE LCSW

Information about “1962762534” NPI (LORI JO POOLE LCSW) exists in 1962762534 in HTML format HTML  |  1962762534 in plain Text format TXT  |  1962762534 in PDF (Portable Document Format) PDF  |  1962762534 in an XML format XML  formats.

NPI Number : 1962762534 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1962762534",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "POOLE",
    "FirstName": "LORI",
    "MiddleName": "JO",
    "NamePrefix": "MS.",
    "NameSuffix": null,
    "Credential": "LCSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "7615 MCMULLEN ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BOISE",
    "MailingAddressStateName": "ID",
    "MailingAddressPostalCode": "83709-0836",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "208-861-0798",
    "MailingAddressFaxNumber": "208-514-2718",
    "FirstLinePracticeLocationAddress": "818 NW 15TH ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MERIDIAN",
    "PracticeLocationAddressStateName": "ID",
    "PracticeLocationAddressPostalCode": "83642-3724",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "208-888-5566",
    "PracticeLocationAddressFaxNumber": "208-888-5578",
    "EnumerationDate": "05/16/2012",
    "LastUpdateDate": "10/08/2019",
    "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": "LMSW-28421",
        "LicenseNumberStateCode": "ID",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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