1972905669 NPI number — KATHLEEN HELEN WYSZACKI DURHAM B.S., B.A.

NPI Number: 1972905669
Health Care Provider/Practitioner: KATHLEEN HELEN WYSZACKI DURHAM B.S., B.A.

NPI Number : 1972905669 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1972905669",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WYSZACKI DURHAM",
    "FirstName": "KATHLEEN",
    "MiddleName": "HELEN",
    "NamePrefix": "MS.",
    "NameSuffix": null,
    "Credential": "B.S.,  B.A.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "WYSZACKI",
    "OtherFirstName": "KATHLEEN",
    "OtherMiddleName": "HELEN",
    "OtherNamePrefix": "MS.",
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "21190 ANDOVER RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SOUTHFIELD",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "48076-3190",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "24424 W MCNICHOLS RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "DETROIT",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "48219-3653",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "313-255-0900",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/24/2014",
    "LastUpdateDate": "09/24/2014",
    "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": "101YA0400X",
          "TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YM0800X",
          "TaxonomyName": "Mental Health Counselor",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}