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General NPI Number Information
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NPI Number | 1316508997
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Entity Type | Individual
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Provider Name | GARY AMLONG
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Gender | Male
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Dates
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Enumeration Date | 06/25/2019
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Last Update Date | 08/27/2021
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Provider Practice Location Address
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Address Line | 2820 DARDENNE LINKS DR
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City | O FALLON
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State | MO
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Zip | 63368-9741
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Country | US
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Telephone | 636-357-2951
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2153 DEPT 8116
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City | BIRMINGHAM
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State | AL
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Zip | 35287-8116
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Country | US
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Telephone | 636-675-5471
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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 | 235500000X
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Taxonomy Name | Speech/Language/Hearing Specialist/Technologist
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License Number |
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License Number State |
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