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General NPI Number Information
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NPI Number | 1275882045
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Entity Type | Organization
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Legal Business Name | TRU THERAPY, LLC
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Dates
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Enumeration Date | 09/07/2012
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Last Update Date | 09/07/2012
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Provider Practice Location Address
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Address Line | 1818 AVENUE OF AMERICA
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City | MONROE
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State | LA
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Zip | 71201-4530
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Country | US
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Telephone | 318-537-4862
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Fax |
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Provider Business Mailing Address
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Address Line | 1818 AVENUE OF AMERICA
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City | MONROE
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State | LA
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Zip | 71201-4530
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Country | US
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Telephone | 318-537-4862
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Fax |
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Authorized Official
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Title or Position | OWNER/SPEECH PATHOLOGIST
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Name | STACIE N BROWN
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Credential | MS
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Telephone | 318-537-4862
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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 | 6216
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License Number State | LA
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