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General NPI Number Information
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NPI Number | 1093473159
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Entity Type | Individual
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Provider Name | OLIVIA SHEA RUSSELL M.S., CF-SLP
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Gender | Female
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Dates
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Enumeration Date | 12/06/2021
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Last Update Date | 12/06/2021
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Provider Practice Location Address
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Address Line | 14651 DALLAS PKWY STE 200
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City | DALLAS
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State | TX
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Zip | 75254-8856
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Country | US
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Telephone | 866-919-3240
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Fax |
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Provider Business Mailing Address
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Address Line | 11721 RED OAK VALLEY LN
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City | AUSTIN
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State | TX
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Zip | 78732-2406
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Country | US
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Telephone | 512-569-0388
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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 | 119148
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License Number State | TX
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