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General NPI Number Information
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NPI Number | 1053053868
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Entity Type | Individual
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Provider Name | ANGELA BULTEMEIER MS CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 04/12/2022
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Last Update Date | 04/12/2022
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Provider Practice Location Address
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Address Line | 801 CRAWFORD ST
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City | PORTSMOUTH
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State | VA
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Zip | 23704-3822
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Country | US
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Telephone | 757-393-8751
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Fax |
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Provider Business Mailing Address
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Address Line | 2300 WINDY RIDGE PKWY SE STE 825S
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City | ATLANTA
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State | GA
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Zip | 30339-5665
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Country | US
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Telephone | 770-218-6274
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Fax |
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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 | 2202010361
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License Number State | VA
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