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General NPI Number Information
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NPI Number | 1588265409
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Entity Type | Individual
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Provider Name | AMANDA GOODWIN
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Gender | Female
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Dates
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Enumeration Date | 11/06/2020
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Last Update Date | 11/06/2020
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Provider Practice Location Address
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Address Line | 510 MAIN ST
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City | CLAYTON
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State | DE
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Zip | 19938-7716
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Country | US
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Telephone | 302-653-2803
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Fax |
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Provider Business Mailing Address
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Address Line | 304 CREST AVE
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City | HADDON HEIGHTS
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State | NJ
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Zip | 08035-1421
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Country | US
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Telephone |
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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 | O4-0010717
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License Number State | DE
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