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General NPI Number Information
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NPI Number | 1336538578
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Entity Type | Organization
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Legal Business Name | WELLSPRING REHABILITATION SERVICES LLC
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Dates
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Enumeration Date | 01/12/2015
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Last Update Date | 03/18/2021
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Provider Practice Location Address
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Address Line | 255 W MAIN ST APT E
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City | ISLAND
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State | KY
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Zip | 42350-2179
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Country | US
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Telephone | 812-760-7090
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Fax | 812-205-2425
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Provider Business Mailing Address
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Address Line | 1124 SE 1ST ST
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City | EVANSVILLE
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State | IN
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Zip | 47713-1322
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Country | US
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Telephone | 812-760-0709
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SHEILA A EVANS
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Credential | MSCCCSLP
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Telephone | 812-760-0709
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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 |
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License Number State |
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