{
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"FirstLineMailingAddress": "4501 HILLSIDE DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ROGERS",
"MailingAddressStateName": "AR",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "479-502-7207",
"MailingAddressFaxNumber": "479-636-1595",
"FirstLinePracticeLocationAddress": "2474 E JOYCE BLVD",
"SecondLinePracticeLocationAddress": "SUITE 2",
"PracticeLocationAddressCityName": "FAYETTEVILLE",
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"EnumerationDate": "04/18/2006",
"LastUpdateDate": "08/22/2020",
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"NPIReactivationDate": null,
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"AuthorizedOfficialLastName": "WATSON",
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"AuthorizedOfficialCredential": "M.ED.,CCC-SLP",
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"Taxonomy": {
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"TaxonomyName": "Speech-Language Pathologist",
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}
},
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}
}
}
}