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General NPI Number Information
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NPI Number | 1518213990
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Entity Type | Organization
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Legal Business Name | PRAESTOSPEECH SLP PLLC
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Dates
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Enumeration Date | 08/03/2012
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Last Update Date | 08/03/2012
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Provider Practice Location Address
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Address Line | 4714 UTOPIA PKWY
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City | FLUSHING
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State | NY
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Zip | 11358-3838
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Country | US
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Telephone | 917-270-6177
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Fax | 718-428-0506
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Provider Business Mailing Address
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Address Line | 4714 UTOPIA PKWY
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City | FLUSHING
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State | NY
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Zip | 11358-3838
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Country | US
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Telephone | 917-270-6177
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Fax | 718-428-0506
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Authorized Official
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Title or Position | SPEECH PATHOLOGIST
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Name | MRS. JOANN ARBORE MAINARDI
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Credential | CCC-SLP
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Telephone | 917-270-6177
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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 | 007541
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License Number State | NY
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