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General NPI Number Information
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NPI Number | 1164897229
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Entity Type | Individual
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Provider Name | HEIDI FACCINI CCC/LSP
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Gender | Female
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Dates
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Enumeration Date | 12/01/2015
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Last Update Date | 12/01/2015
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Provider Practice Location Address
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Address Line | 35 CARMAN RD
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City | DIX HILLS
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State | NY
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Zip | 11746-5651
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Country | US
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Telephone | 631-549-5580
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Fax |
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Provider Business Mailing Address
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Address Line | 241 CEDAR AVE
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City | ISLIP
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State | NY
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Zip | 11751-4610
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Country | US
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Telephone | 631-650-1911
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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 | 005396
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License Number State | NY
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