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General NPI Number Information
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NPI Number | 1225681281
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Entity Type | Individual
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Provider Name | MADALYN FORRESTER
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Gender | Female
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Dates
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Enumeration Date | 07/18/2019
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Last Update Date | 07/18/2019
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Provider Practice Location Address
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Address Line | 17461 DERIAN AVE
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City | IRVINE
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State | CA
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Zip | 92614-5843
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Country | US
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Telephone | 949-412-6825
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Fax |
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Provider Business Mailing Address
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Address Line | 26795 CALLE REAL
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City | CAPISTRANO BEACH
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State | CA
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Zip | 92624-1506
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Country | US
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Telephone | 949-412-6825
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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 | 28489
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License Number State | CA
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