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General NPI Number Information
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NPI Number | 1518121847
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Entity Type | Individual
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Provider Name | APRIL REED WALLACE CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 07/16/2008
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Last Update Date | 03/19/2011
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Provider Practice Location Address
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Address Line | 120 VETERANS DR
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City | OXFORD
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State | MS
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Zip | 38655-3578
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Country | US
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Telephone | 662-232-8070
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Fax |
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Provider Business Mailing Address
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Address Line | 136 YOCONA RIDGE RD
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City | OXFORD
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State | MS
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Zip | 38655-6904
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Country | US
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Telephone | 662-832-4086
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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 | 0000003185
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License Number State | TN
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