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General NPI Number Information
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NPI Number | 1043666993
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Entity Type | Individual
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Provider Name | DEVON AMANDA IDALSKI MS, CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 05/10/2016
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Last Update Date | 12/01/2022
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Provider Practice Location Address
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Address Line | 109 N 2ND AVE STE 203
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City | ALPENA
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State | MI
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Zip | 49707-5305
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Country | US
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Telephone | 989-278-8747
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Fax | 989-331-6705
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Provider Business Mailing Address
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Address Line | 16461 PINE ST
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City | PRESQUE ISLE
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State | MI
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Zip | 49777-8653
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Country | US
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Telephone | 810-305-0627
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Fax | 989-331-6705
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 7101005109
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License Number State | MI
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