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General NPI Number Information
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NPI Number | 1245726066
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Entity Type | Individual
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Provider Name | MELANIE ILYSA ALBAUM
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Gender | Female
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Dates
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Enumeration Date | 07/04/2018
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Last Update Date | 07/04/2018
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Provider Practice Location Address
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Address Line | 275 W DUNDEE RD
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City | BUFFALO GROVE
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State | IL
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Zip | 60089-3704
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Country | US
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Telephone | 847-648-1915
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Fax |
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Provider Business Mailing Address
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Address Line | 6504 N SAUGANASH AVE
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City | LINCOLNWOOD
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State | IL
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Zip | 60712-3018
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Country | US
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Telephone |
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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 | 146.014326
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License Number State | IL
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