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General NPI Number Information
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NPI Number | 1326143850
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Entity Type | Individual
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Provider Name | JULIE RAE SKOKAN MACCCSLP
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Gender | Female
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Dates
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Enumeration Date | 09/13/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5842 BLACKSHIRE PATH SUITE 201
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City | INVER GROVE HEIGHTS
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State | MN
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Zip | 55076-1619
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Country | US
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Telephone | 651-554-9940
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Fax | 651-554-9941
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Provider Business Mailing Address
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Address Line | 8056 INGLESIDE AVE S
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City | COTTAGE GROVE
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State | MN
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Zip | 55016-3233
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Country | US
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Telephone | 651-768-0115
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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 | 7330
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License Number State | MN
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