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General NPI Number Information
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NPI Number | 1245973593
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Entity Type | Organization
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Legal Business Name | AUTISM REC
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Dates
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Enumeration Date | 04/14/2022
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Last Update Date | 04/14/2022
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Provider Practice Location Address
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Address Line | 1140 S 26TH ST
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City | PHILADELPHIA
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State | PA
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Zip | 19146-3849
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Country | US
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Telephone | 215-200-0405
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 605
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City | DARBY
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State | PA
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Zip | 19023-0605
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Country | US
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Telephone | 215-200-0405
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Fax |
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Authorized Official
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Title or Position | SPEECH THERAPIST
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Name | JACQUELINE LACINSKI
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Credential | MA, CCC-SLP
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Telephone | 484-326-9900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number |
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License Number State |
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