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General NPI Number Information
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NPI Number | 1427763622
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Entity Type | Individual
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Provider Name | DAIJAH FOGLE
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Gender | Female
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Dates
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Enumeration Date | 01/23/2023
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Last Update Date | 11/21/2023
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Provider Practice Location Address
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Address Line | 1936 OPITZ BLVD STE A
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City | WOODBRIDGE
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State | VA
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Zip | 22191-3360
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Country | US
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Telephone | 540-841-4443
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Fax |
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Provider Business Mailing Address
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Address Line | 4521 COTSWOLD MANOR LOOP
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City | WOODBRIDGE
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State | VA
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Zip | 22192-5472
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Country | US
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Telephone | 803-381-1177
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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 |
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