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General NPI Number Information
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NPI Number | 1265741029
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Entity Type | Individual
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Provider Name | CINDY JO BUSHELL MA, CCC,SLP
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Gender | Female
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Dates
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Enumeration Date | 09/28/2010
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Last Update Date | 09/28/2010
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Provider Practice Location Address
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Address Line | 3555 W RENO AVE SUITE F
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City | LAS VEGAS
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State | NV
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Zip | 89118-1609
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Country | US
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Telephone | 702-262-0037
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Fax |
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Provider Business Mailing Address
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Address Line | 2532 MONARCH BAY DRIVE
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City | LAS VEGAS
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State | NV
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Zip | 89128
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Country | US
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Telephone | 702-328-6345
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Fax | 702-562-9248
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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 | SP1185
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License Number State | NV
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