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1972885440 NPI number — JACLYN GRAD PH.D.

NPI Number: 1972885440
Health Care Provider/Practitioner: JACLYN GRAD PH.D.

Information about “1972885440” NPI (JACLYN GRAD PH.D.) exists in 1972885440 in HTML format HTML  |  1972885440 in plain Text format TXT  |  1972885440 in PDF (Portable Document Format) PDF  |  1972885440 in an XML format XML  formats.

NPI Number : 1972885440 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1972885440",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GRAD",
    "FirstName": "JACLYN",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PH.D.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "PETERS",
    "OtherFirstName": "JACLYN",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "PO BOX 280148",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "JACKSONVILLE",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "32228-0148",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "904-270-4338",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "3851 ROGER BROOKE DR",
    "SecondLinePracticeLocationAddress": "MCHEQD",
    "PracticeLocationAddressCityName": "FORT SAM HOUSTON",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "78234-4501",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "210-916-2460",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/12/2011",
    "LastUpdateDate": "02/19/2014",
    "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": "103T00000X",
        "TaxonomyName": "Psychologist",
        "LicenseNumber": "001304",
        "LicenseNumberStateCode": "IA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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