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General NPI Number Information
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NPI Number | 1417406281
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Entity Type | Individual
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Provider Name | SANDY REESON
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Gender | Female
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Dates
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Enumeration Date | 09/22/2016
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Last Update Date | 06/16/2025
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Provider Practice Location Address
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Address Line | 773 BANDIT TRL
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City | KELLER
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State | TX
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Zip | 76248-0111
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Country | US
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Telephone | 830-399-5364
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Fax |
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Provider Business Mailing Address
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Address Line | 5040 CASSIDY LN
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City | FORT WORTH
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State | TX
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Zip | 76244-9171
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Country | US
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Telephone | 830-399-5364
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 2653
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License Number State | TX
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