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General NPI Number Information
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NPI Number | 1083747059
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Entity Type | Individual
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Provider Name | STACIE PEARL CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 141 S CENTRAL AVE SUITE #305
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City | HARTSDALE
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State | NY
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Zip | 10530-2319
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Country | US
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Telephone | 914-428-8004
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Fax | 914-428-8003
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Provider Business Mailing Address
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Address Line | 10 HIGH ST
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City | KATONAH
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State | NY
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Zip | 10536-1120
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Country | US
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Telephone | 914-301-5091
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Fax | 914-428-8004
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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 | 011483-1
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License Number State | NY
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