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General NPI Number Information
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NPI Number | 1386210672
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Entity Type | Individual
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Provider Name | KELLY MEDINA M.S., CF-SLP, TSSLD
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Gender | Female
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Dates
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Enumeration Date | 05/27/2021
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Last Update Date | 05/27/2021
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Provider Practice Location Address
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Address Line | 690 OTAY LAKES RD
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City | CHULA VISTA
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State | CA
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Zip | 91910-8904
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Country | US
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Telephone | 619-475-6910
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Fax |
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Provider Business Mailing Address
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Address Line | 2470 HILTON HEAD PL APT 1174
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City | EL CAJON
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State | CA
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Zip | 92019-4431
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Country | US
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Telephone | 516-710-9190
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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 |
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License Number State | CA
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