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General NPI Number Information
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NPI Number | 1154539849
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Entity Type | Organization
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Legal Business Name | CHILD FIRST DEVELOPMENTAL SERVICES
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 14511 HEARTHSIDE CT
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City | LOUISVILLE
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State | KY
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Zip | 40245-3953
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Country | US
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Telephone | 502-807-8711
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Fax |
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Provider Business Mailing Address
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Address Line | 14511 HEARTHSIDE CT
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City | LOUISVILLE
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State | KY
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Zip | 40245-3953
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Country | US
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Telephone | 502-807-8711
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. GARY A SIMPSON
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Credential | MS,CCC-SLP
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Telephone | 502-807-8711
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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 | 2042
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License Number State | KY
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