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General NPI Number Information
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NPI Number | 1104163963
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Entity Type | Organization
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Legal Business Name | INTEGRATED SPEECH THERAPY LLC
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Dates
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Enumeration Date | 01/12/2013
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Last Update Date | 01/12/2013
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Provider Practice Location Address
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Address Line | 10105 AVENIDA DEL RIO
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City | DELRAY BEACH
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State | FL
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Zip | 33446-2423
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Country | US
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Telephone | 561-702-3965
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Fax | 561-638-5880
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Provider Business Mailing Address
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Address Line | 10105 AVENIDA DEL RIO
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City | DELRAY BEACH
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State | FL
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Zip | 33446-2423
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Country | US
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Telephone | 561-702-3965
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Fax | 561-638-5880
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANDREA GOTTLIEB
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Credential | MS CCC/SLP
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Telephone | 561-702-3965
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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 | SA5309
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License Number State | FL
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